Impact of Isoniazid Preventive Therapy for HIV-Infected Adults in Rio de Janeiro, Brazil: An Epidemiological Model
Impact of Isoniazid Preventive Therapy for HIV-Infected Adults in Rio de Janeiro, Brazil: An Epidemiological Model
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DOI：
10.1097/qai.0000000000000219
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发表时间：
2014-08-15
影响因子：
3.6
通讯作者：
Durovni, Betina
中科院分区：
文献类型：
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作者：
Dowdy, David W.;Golub, Jonathan E.;Durovni, Betina
背景资料：异烟肼预防性治疗（IPT）的潜在流行病学影响仍然不确定，在现代中等负担环境中，可以在艾滋病毒感染者（PLHIV）中切实扩大其水平。我们使用的常规监测和实施数据来自一项在巴西里约热内卢接受抗逆转录病毒治疗的HIV感染者中进行的IPT随机分组试验，来建立结核病/艾滋病的简单传播模式。我们将IPT交付建模为一个持续的过程，每年捕获一定比例的合格人群。我们预计可行的减少结核病的发病率和死亡率在一般人群中，特别是在5年结束后，实施IPT programme.Results：IPT的时间数据拟合指数曲线，这表明，IPT是交付的速度覆盖20%（95%置信区间：16%至24%）的2500个合格的个人每年。到模拟方案推出后第5年年底，IPT使普通人群的结核病发病率降低了3.0% [95%不确定性范围（UR）：1.6%至7.2%]，使艾滋病毒感染者的发病率降低了15.6%（95% UR：15.5%至36.5%）。结核病死亡率相应降低4.0%（95% UR：2.2%至10.3%）和14.3%（14.6%至33.7%）。结果是强大的参数值的灵敏度analysis.Conclusions：结核病筛查和IPT交付可以大大降低结核病发病率和死亡率之间的PLHIV在城市，中等负担的设置。在这种情况下，IPT可以成为切实减少艾滋病毒感染者结核病负担的多方面战略的重要组成部分。
Background: The potential epidemiological impact of isoniazid preventive therapy (IPT), delivered at levels that could be feasibly scaled up among people living with HIV (PLHIV) in modern, moderate-burden settings, remains uncertain.Methods: We used routine surveillance and implementation data from a cluster-randomized trial of IPT among HIV-infected clinic patients with good access to antiretroviral therapy in Rio de Janeiro, Brazil, to populate a parsimonious transmission model of tuberculosis (TB)/HIV. We modeled IPT delivery as a constant process capturing a proportion of the eligible population every year. We projected feasible reductions in TB incidence and mortality in the general population and among PLHIV specifically at the end of 5 years after implementing an IPT program.Results: Data on time to IPT fit an exponential curve well, suggesting that IPT was delivered at a rate covering 20% (95% confidence interval: 16% to 24%) of the 2500 eligible individuals each year. By the end of year 5 after modeled program rollout, IPT had reduced TB incidence by 3.0% [95% uncertainty range (UR): 1.6% to 7.2%] in the general population and by 15.6% (95% UR: 15.5% to 36.5%) among PLHIV. Corresponding reductions in TB mortality were 4.0% (95% UR: 2.2% to 10.3%) and 14.3% (14.6% to 33.7%). Results were robust to wide variations in parameter values on sensitivity analysis.Conclusions: TB screening and IPT delivery can substantially reduce TB incidence and mortality among PLHIV in urban, moderate-burden settings. In such settings, IPT can be an important component of a multi-faceted strategy to feasibly reduce the burden of TB in PLHIV.