Projected population-wide impact of antiretroviral therapy-linked isoniazid preventive therapy in a high-burden setting. Kendall, E. A, Azman, A. S, Maartens, G., Boulle, A., Wilkinson, R. J, Dowdy, D. W, & Rangaka, M. X AIDS, 33(3):525–536, oct, 2019. ![Projected population-wide impact of antiretroviral therapy-linked isoniazid preventive therapy in a high-burden setting [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex Objective: Both isoniazid preventive therapy (IPT) and antiretroviral therapy (ART) reduce tuberculosis risk in individuals living with HIV. We sought to estimate the broader, population-wide impact of providing a pragmatically-implemented 12-month IPT regimen to ART recipients in a high-burden community. Design: Dynamic transmission model of a tuberculosis-HIV epidemic, calibrated to site-specific, historical epidemiologic and clinical trial data from Khayelitsha, South Africa. Methods: We projected the five-year impact of delivering a 12-month IPT regimen community-wide to 85% of new ART initiators and 15%/year of those already on ART, accounting for IPT-attributable reductions in TB infection, progression, and transmission. We also evaluated scenarios of continuously-delivered IPT, ongoing ART scale-up, and lower tuberculosis incidence. Results: Under historical (early 2010 s) ART coverage, this ART-linked IPT intervention prevented one tuberculosis case per 18 (95% credible interval [CrI] 11–29) people treated. It lowered tuberculosis incidence by a projected 23% (95%CrI 14–30%) among people receiving ART, and by 5.2% (95%CrI 2.9–8.7%) in the total population. Continuous IPT reduced the number needed to treat to prevent one case of tuberculosis to 10 (95%CrI 7–16), though it required 74% more person-years of therapy (95%CrI 64–94%) to prevent one TB case, relative to 12-month therapy. Under expanding ART coverage, the tuberculosis incidence reduction achieved by 12-month IPT grew to 7.6% (95%CrI 4.3–12.6%). Effect sizes were similar in a simulated setting of lower tuberculosis incidence. Conclusions: IPT in conjunction with ART reduces tuberculosis incidence among those who receive therapy and has additional impact on tuberculosis transmission in the population.
@article{Kendall2018,
abstract = {Objective: Both isoniazid preventive therapy (IPT) and antiretroviral therapy (ART) reduce tuberculosis risk in individuals living with HIV. We sought to estimate the broader, population-wide impact of providing a pragmatically-implemented 12-month IPT regimen to ART recipients in a high-burden community. Design: Dynamic transmission model of a tuberculosis-HIV epidemic, calibrated to site-specific, historical epidemiologic and clinical trial data from Khayelitsha, South Africa. Methods: We projected the five-year impact of delivering a 12-month IPT regimen community-wide to 85{\%} of new ART initiators and 15{\%}/year of those already on ART, accounting for IPT-attributable reductions in TB infection, progression, and transmission. We also evaluated scenarios of continuously-delivered IPT, ongoing ART scale-up, and lower tuberculosis incidence. Results: Under historical (early 2010 s) ART coverage, this ART-linked IPT intervention prevented one tuberculosis case per 18 (95{\%} credible interval [CrI] 11–29) people treated. It lowered tuberculosis incidence by a projected 23{\%} (95{\%}CrI 14–30{\%}) among people receiving ART, and by 5.2{\%} (95{\%}CrI 2.9–8.7{\%}) in the total population. Continuous IPT reduced the number needed to treat to prevent one case of tuberculosis to 10 (95{\%}CrI 7–16), though it required 74{\%} more person-years of therapy (95{\%}CrI 64–94{\%}) to prevent one TB case, relative to 12-month therapy. Under expanding ART coverage, the tuberculosis incidence reduction achieved by 12-month IPT grew to 7.6{\%} (95{\%}CrI 4.3–12.6{\%}). Effect sizes were similar in a simulated setting of lower tuberculosis incidence. Conclusions: IPT in conjunction with ART reduces tuberculosis incidence among those who receive therapy and has additional impact on tuberculosis transmission in the population.},
author = {Kendall, Emily A and Azman, Andrew S and Maartens, Gary and Boulle, Andrew and Wilkinson, Robert J and Dowdy, David W and Rangaka, Molebogeng X},
doi = {10.1097/QAD.0000000000002053},
isbn = {0000000000},
issn = {0269-9370},
journal = {AIDS},
keywords = {fund{\_}ack,original},
mendeley-tags = {fund{\_}ack,original},
month = {oct},
number = {3},
pages = {525--536},
pmid = {30325773},
title = {{Projected population-wide impact of antiretroviral therapy-linked isoniazid preventive therapy in a high-burden setting}},
url = {https://journals.lww.com/aidsonline/fulltext/2019/03010/Projected{\_}population{\_}wide{\_}impact{\_}of{\_}antiretroviral.21.aspx},
volume = {33},
year = {2019}
}
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Methods: We projected the five-year impact of delivering a 12-month IPT regimen community-wide to 85% of new ART initiators and 15%/year of those already on ART, accounting for IPT-attributable reductions in TB infection, progression, and transmission. We also evaluated scenarios of continuously-delivered IPT, ongoing ART scale-up, and lower tuberculosis incidence. Results: Under historical (early 2010 s) ART coverage, this ART-linked IPT intervention prevented one tuberculosis case per 18 (95% credible interval [CrI] 11–29) people treated. It lowered tuberculosis incidence by a projected 23% (95%CrI 14–30%) among people receiving ART, and by 5.2% (95%CrI 2.9–8.7%) in the total population. Continuous IPT reduced the number needed to treat to prevent one case of tuberculosis to 10 (95%CrI 7–16), though it required 74% more person-years of therapy (95%CrI 64–94%) to prevent one TB case, relative to 12-month therapy. Under expanding ART coverage, the tuberculosis incidence reduction achieved by 12-month IPT grew to 7.6% (95%CrI 4.3–12.6%). Effect sizes were similar in a simulated setting of lower tuberculosis incidence. Conclusions: IPT in conjunction with ART reduces tuberculosis incidence among those who receive therapy and has additional impact on tuberculosis transmission in the population.","author":[{"propositions":[],"lastnames":["Kendall"],"firstnames":["Emily","A"],"suffixes":[]},{"propositions":[],"lastnames":["Azman"],"firstnames":["Andrew","S"],"suffixes":[]},{"propositions":[],"lastnames":["Maartens"],"firstnames":["Gary"],"suffixes":[]},{"propositions":[],"lastnames":["Boulle"],"firstnames":["Andrew"],"suffixes":[]},{"propositions":[],"lastnames":["Wilkinson"],"firstnames":["Robert","J"],"suffixes":[]},{"propositions":[],"lastnames":["Dowdy"],"firstnames":["David","W"],"suffixes":[]},{"propositions":[],"lastnames":["Rangaka"],"firstnames":["Molebogeng","X"],"suffixes":[]}],"doi":"10.1097/QAD.0000000000002053","isbn":"0000000000","issn":"0269-9370","journal":"AIDS","keywords":"fund_ack,original","mendeley-tags":"fund_ack,original","month":"oct","number":"3","pages":"525–536","pmid":"30325773","title":"Projected population-wide impact of antiretroviral therapy-linked isoniazid preventive therapy in a high-burden setting","url":"https://journals.lww.com/aidsonline/fulltext/2019/03010/Projected\\_population\\_wide\\_impact\\_of\\_antiretroviral.21.aspx","volume":"33","year":"2019","bibtex":"@article{Kendall2018,\r\nabstract = {Objective: Both isoniazid preventive therapy (IPT) and antiretroviral therapy (ART) reduce tuberculosis risk in individuals living with HIV. We sought to estimate the broader, population-wide impact of providing a pragmatically-implemented 12-month IPT regimen to ART recipients in a high-burden community. Design: Dynamic transmission model of a tuberculosis-HIV epidemic, calibrated to site-specific, historical epidemiologic and clinical trial data from Khayelitsha, South Africa. Methods: We projected the five-year impact of delivering a 12-month IPT regimen community-wide to 85{\\%} of new ART initiators and 15{\\%}/year of those already on ART, accounting for IPT-attributable reductions in TB infection, progression, and transmission. We also evaluated scenarios of continuously-delivered IPT, ongoing ART scale-up, and lower tuberculosis incidence. Results: Under historical (early 2010 s) ART coverage, this ART-linked IPT intervention prevented one tuberculosis case per 18 (95{\\%} credible interval [CrI] 11–29) people treated. It lowered tuberculosis incidence by a projected 23{\\%} (95{\\%}CrI 14–30{\\%}) among people receiving ART, and by 5.2{\\%} (95{\\%}CrI 2.9–8.7{\\%}) in the total population. Continuous IPT reduced the number needed to treat to prevent one case of tuberculosis to 10 (95{\\%}CrI 7–16), though it required 74{\\%} more person-years of therapy (95{\\%}CrI 64–94{\\%}) to prevent one TB case, relative to 12-month therapy. Under expanding ART coverage, the tuberculosis incidence reduction achieved by 12-month IPT grew to 7.6{\\%} (95{\\%}CrI 4.3–12.6{\\%}). Effect sizes were similar in a simulated setting of lower tuberculosis incidence. 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