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IPT in people living with HIV in Myanmar: a five-fold decrease in incidence of TB disease and all-cause mortality.

N T T Kyaw1, A M V Kumar2, K W Y Kyaw3

  • 1International Union Against Tuberculosis and Lung Disease (The Union), Myanmar Office, Mandalay, Myanmar, Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia, USA.

The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease
|March 16, 2019
PubMed
Summary

Isoniazid preventive therapy (IPT) significantly lowers the risk of tuberculosis (TB) disease and death in people living with HIV (PLHIV) in Myanmar. Completing IPT offers the most protection against TB and mortality in this high-burden population.

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Area of Science:

  • Public Health
  • Infectious Diseases
  • Epidemiology

Background:

  • Myanmar faces a substantial burden of co-occurring HIV and tuberculosis (TB).
  • Diagnostic tools for latent tuberculous infection are not routinely accessible in Myanmar.
  • This highlights a critical need for effective TB prevention strategies among people living with HIV (PLHIV).

Purpose of the Study:

  • To evaluate the impact of isoniazid preventive therapy (IPT) on TB disease incidence.
  • To assess the effect of IPT on mortality rates among PLHIV.
  • To provide evidence for TB prevention in a high-burden setting.

Main Methods:

  • Retrospective cohort study utilizing routinely collected data.
  • Inclusion of PLHIV enrolled in care between 2009 and 2014.
  • Analysis of TB incidence and mortality based on IPT receipt and completion.

Main Results:

  • Of 7177 PLHIV, 18% received IPT, with 67% completing the course.
  • Completing IPT was associated with a significantly lower risk of incident TB (aHR 0.21).
  • IPT receipt significantly reduced the risk of death (aHR 0.25 for completion, aHR 0.55 for non-completion).

Conclusions:

  • Completing isoniazid preventive therapy substantially reduces TB disease risk in PLHIV in Myanmar.
  • IPT is an effective intervention for reducing mortality among PLHIV.
  • These findings support the integration of IPT into HIV care programs in high-burden settings.