PREVENTIVE CHEMOTHERAPY FOR HIV-ASSOCIATED TUBERCULOSIS IN UGANDA - AN OPERATIONAL ASSESSMENT AT A VOLUNTARY COUNSELING AND TESTING CENTER
PREVENTIVE CHEMOTHERAPY FOR HIV-ASSOCIATED TUBERCULOSIS IN UGANDA - AN OPERATIONAL ASSESSMENT AT A VOLUNTARY COUNSELING AND TESTING CENTER
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DOI：
10.1097/00002030-199509030-00008
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发表时间：
1995-03-01
期刊：
影响因子：
3.8
通讯作者：
ENGWAU, FA
中科院分区：
文献类型：
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作者：
AISU, T;RAVIGLIONE, MC;ENGWAU, FA
目的：评估乌干达坎帕拉独立艾滋病毒自愿咨询和检测中心鉴定出的艾滋病毒和结核分枝杆菌双重感染者的异烟肼预防性化疗（IPT）治疗结核病的操作情况。设计：对艾滋病毒感染者进行咨询，通过体检排除活动性结核病，并提供纯化的蛋白衍生物 (PPD) 皮肤测试。 PPD 阳性患者每日服用异烟肼 300 毫克，持续 6 个月。提供药物，并每月评估毒性和依从性。还对服务的利用、成本和可持续性进行了评估。结果：1991年6月14日至1992年9月30日期间，9862人检测出艾滋病毒呈阳性。在返回收集检测结果的 5594 名 HIV 感染者中，只有 1524 名 (27%) 被登记。其中，1344 人接受了结核菌素测试（88%）； 180人因活动性肺结核、重病、拒绝等原因未接受检测。在 1344 人中，250 人（19%）没有返回进行测试读数，515 人呈阴性（47% 的测试读数）。在 579 名结核菌素阳性患者中，有 59 名（10%）因结核病和其他呼吸道疾病而被排除在预防性化疗之外。在 520 名接受异烟肼治疗的人中，62% 的人收集了至少 80% 的药品。没有观察到重大毒性。治疗第一个月出现一例结核病。 HIV 咨询和检测的费用为每人 18.54 美元，后续咨询和社会支持的费用为 7.89 美元。结论：确定了导致人员流失的重要因素，例如咨询师在 HIV 检测前和检测后咨询期间讨论结核病问题的动力有限、医疗筛查的可用性不足、收集药物的地点转移以及频繁的结核菌素阴性检测。 6% 的筛查人群患有活动性结核病，这表明自愿咨询和检测场所对于发现结核病病例可能很重要，并强调需要在开始 IPT 之前仔细排除结核病。在发展中国家，需要进一步研究评估 IPT 在结核病和艾滋病毒/艾滋病规划条件下的可行性。与被动病例发现相比，IPT 的成本效益及其可持续性应在制定国家政策之前进行评估。
Objective: To assess the operational aspects of isoniazid preventive chemotherapy (IPT) for tuberculosis in persons dually infected with HIV and Mycobacterium tuberculosis identified at an independent HIV voluntary counselling and testing centre in Kampala, Uganda.Design: HIV-infected persons were counselled, had active tuberculosis excluded by medical examination, and were offered purified protein derivative (PPD) skin testing. PPD-positive persons were offered isoniazid 300 mg daily for 6 months. Drugs were supplied, and toxicity and compliance were assessed monthly. Utilization of service, cost, and sustainability were also assessed.Results: Between 14 June 1991 and 30 September 1992, 9862 persons tested HIV-positive. Of 5594 HIV-infected clients who returned to collect test results, only 1524 (27%) were enrolled. Of those, 1344 were tuberculin-tested (88%); 180 were not tested because of active tuberculosis, serious illnesses, refusal, and other reasons. Of the 1344, 250 (19%) did not return for test reading and 515 were negative (47% of tests read). Of 579 tuberculin-positive persons, 59 (10%) were excluded from preventive chemotherapy because of tuberculosis and other respiratory illnesses. Of 520 persons given isoniazid, 62% collected at least 80% of their drug supplies. No major toxicity was observed. One case of tuberculosis occurred in the first month of treatment. Cost of HIV counselling and testing was US$18.54 per person and cost of follow-up counselling and social support was US$ 7.89.Conclusions: Important factors were identified which caused attrition, such as limited motivation by counsellors to discuss tuberculosis issues during HIV pre- and post-test counselling, insufficient availability of medical screening, shifting of sites to collect pills, and frequent tuberculin-negative tests. Active tuberculosis among 6% of persons screened suggests that voluntary counselling and testing sites may be important for tuberculosis case finding and underscores the need to exclude tuberculosis carefully before starting IPT. In developing countries, further studies assessing the feasibility of IPT with in tuberculosis and HIV/AIDS programme conditions are needed. Cost-effectiveness of IPT, compared with passive case finding, and its sustainability should be assessed before national policies are established.