The implementation of isoniazid preventive therapy in HIV clinics: the experience from the TB/HIV in Rio (THRio) study.
The implementation of isoniazid preventive therapy in HIV clinics: the experience from the TB/HIV in Rio (THRio) study.
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DOI：
10.1097/01.aids.0000391022.95412.a6
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发表时间：
2010-11
期刊：
影响因子：
--
通讯作者：
Golub JE
中科院分区：
文献类型：
--
作者：
Durovni B;Cavalcante SC;Saraceni V;Vellozo V;Israel G;King BS;Cohn S;Efron A;Pacheco AG;Moulton LH;Chaisson RE;Golub JE
里约热内卢结核病/艾滋病毒(Thrio)研究于2005年9月启动，目的是评估在巴西里约热内卢的29个艾滋病毒诊所实施结核病和艾滋病毒综合治疗战略的影响。Thrio是一项整群随机试验(CRT)，旨在确定对可获得抗逆转录病毒治疗的艾滋病毒门诊患者进行潜伏性结核病的常规筛查和治疗是否将在临床层面上降低结核病发病率。Thrio是有效应对艾滋病/结核病疫情联盟的一部分，该联盟正在实施研究，以评估大胆的新公共卫生模式对控制艾滋病/结核病疫情的影响。29个公共初级艾滋病毒诊所被随机分配了一个日期，开始实施结核病筛查程序，并为结核病/艾滋病毒混合感染患者提供异烟肼预防性治疗。CRT的最终分析预计将在2011年进行。自各诊所实施结核菌素皮试/IPT之日起至2010年8月，1670名艾滋病毒感染患者启动了IPT，其中215人仍在接受治疗。在剩余的1455名患者中，1230名(85%)完成了治疗，只有20名(1.2%)启动IPT的患者报告了导致停止治疗的不良反应。接受HAART的HIV感染患者的IPT完成率(87%)高于未接受HAART的患者(79%，P<；0.01)。TST和IPT的时间在干预后显著减少，但仍然相当长。Thrio数据库的丰富性导致了对这一庞大的艾滋病毒感染患者队列的几项分析，本文对这些分析进行了回顾。在巴西，对艾滋病毒阳性患者实施TST和IPT的国家工作得到了推动，这部分归功于Thrio的基线结果。在里约热内卢，在艾滋病毒患者中扩大IPT的使用是可以实现的，而且依从性高，不良事件少，尽管这一努力需要一系列活动，包括培训、宣传和服务重组。
The TB/HIV in Rio (THRio) study was launched in September 2005 to assess the impact of integrated tuberculosis (TB) and HIV treatment strategies in 29 HIV clinics in Rio de Janeiro, Brazil. THRio is a cluster-randomized trial (CRT) to determine whether routine screening for and treatment of latent TB in HIV clinic patients with access to antiretroviral therapy will reduce TB incidence at the clinic level. THRio is part of the Consortium to Respond Effectively to AIDS/TB Epidemic that is implementing research studies to assess the impact of bold, new public health paradigms for controlling the AIDS/TB epidemic. Twenty-nine public primary HIV clinics were randomly assigned a date to begin implementing TB screening procedures and provision of isoniazid preventive therapy (IPT) for TB/HIV coinfected patients. Final analysis of the CRT is expected in 2011. Starting at date of tuberculin skin test (TST)/IPT implementation at each clinic through August 2010, 1670 HIV-infected patients initiated IPT, of which 215 are still receiving treatment. Of the remaining 1455 patients, 1230 (85%) completed therapy and only 20 (1.2%) patients initiating IPT reported adverse reactions leading to discontinuation of therapy. IPT completion was higher among HIV-infected patients receiving HAART (87%) than those not yet receiving HAART (79%, P < 0.01). Times to TST and IPT have markedly decreased postintervention, but remain considerably long. The richness of the THRio database has resulted in several analyses of this expansive cohort of HIV-infected patients that are reviewed here. The national implementation of TST and IPT for HIV-positive patients in Brazil has been invigorated partly due to THRio’s baseline results. Expanded use of IPT in HIV patients in Rio de Janeiro is achievable with high adherence and low adverse events, although this effort requires a package of activities including training, advocacy and reorganization of services.
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3.8
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