Breakthrough TB among people living with HIV on TB preventive therapy.

IF 1.3 Q4 RESPIRATORY SYSTEM

Public Health Action Pub Date : 2022-12-21 DOI:10.5588/pha.22.0016

S Nyangu, M Kagujje, I Mwaba, D Luhanga, R Hambwalula, S Maliko, T Mushili, E Mwamba, Mukaba Mulai, Monde Muyoyeta

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Abstract

Background: Zambia has an estimated TB incidence of 319/100,000 population and a HIV prevalence of 11.1%. In 2020, only 49% of new people living with HIV (PLHIV) received TB preventive therapy (TPT) in Zambia. Misconceptions about the reliability of symptom screening and drug resistance among people who develop TB while on TPT are barriers to TPT scale-up. We determined the incidence and predictors of breakthrough TB during TPT among PLHIV in Zambia.

Method: This was a retrospective analysis of routine TPT programme data among PLHIV collected between October 2016 and October 2019 from select primary health facilities in Zambia.

Results: Of 48,581 PLHIV enrolled on TPT, 130 (0.3%) developed breakthrough TB during TPT. Of the 130, 90 client records were accessed. The median age of the breakthrough TB cases was 35 years; 68% were males. Overall, 96% of the breakthrough TB cases had been on antiretroviral therapy (ART) for ⩽3 months; 24% were symptomatic at the beginning of TPT, 22% were asymptomatic and others had missing data. Of the 130 breakthrough TB cases, 79% developed TB in the first month after TPT initiation. The median time to TB diagnosis was 10 days (IQR 4-16).

Conclusion: Breakthrough TB during TPT is rare among PHLIV on ART, and very rare after the first month of TPT initiation. It should therefore not be a barrier to TPT scale-up.

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艾滋病毒感染者结核病预防治疗取得突破性进展。

背景:赞比亚估计结核病发病率为319/10万人，艾滋病毒患病率为11.1%。2020年，赞比亚只有49%的新发艾滋病毒感染者接受了结核病预防治疗。对症状筛查的可靠性和在接受TPT治疗期间出现结核病患者的耐药性的误解是扩大TPT治疗的障碍。我们确定了赞比亚艾滋病毒感染者TPT治疗期间突破性结核病的发病率和预测因素。方法:回顾性分析2016年10月至2019年10月从赞比亚选定的初级卫生机构收集的艾滋病毒感染者常规TPT规划数据。结果:在接受TPT治疗的48,581名PLHIV患者中，130名(0.3%)在TPT治疗期间发展为突破性结核病。在这130条记录中，有90条客户记录被访问。突破结核病例的中位年龄为35岁;68%是男性。总体而言，96%的突破性结核病例已接受抗逆转录病毒治疗(ART)≥3个月;24%的患者在TPT开始时有症状，22%的患者无症状，其他患者数据缺失。在130例突破性结核病例中，79%在开始TPT治疗后的第一个月发生结核。到结核诊断的中位时间为10天(IQR 4-16)。结论:在接受抗逆转录病毒治疗的PHLIV患者中，TPT治疗期间出现突破结核的情况非常罕见，而在TPT治疗开始的第一个月后更是非常罕见。因此，它不应成为扩大TPT的障碍。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Public Health Action RESPIRATORY SYSTEM-

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期刊介绍： Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.