Chemoprophylaxis for tuberculosis in HIV-infected individuals in sub-Saharan Africa

Abstract

Objective: To examine the role of chemoprophylaxis as a public health strategy for the control of tuberculosis in sub-Saharan Africa.

Data sources: Published literature regarding efficacy, cost-effectiveness and operational feasibility of chemoprophylaxis programmes.

Study selection: Studies mainly published from countries in sub-Saharan Africa and other low income countries.

Data extraction: Manual search of journals and computer search of data bases.

Data synthesis: Latent infection with tuberculosis among adults in sub-Saharan Africa is more than 50% and HIV infection in the same age group is more than 10%. TB treatment programmes in the region are overwhelmed by increasing numbers of clinical TB. The efficacy and safety of isoniazid preventing TB among HIV infected individuals has been demonstrated in various studies. Though data on its cost-effectiveness is limited, computer modelling show that chemoprophylaxis for HIV associated tuberculosis is more cost-effective than chemotherapy. A national chemoprophylaxis programme need to achieve three broad objectives: HIV testing and counselling; tuberculin testing and exclusion of active TB; and to achieve high enough compliance rates. These objectives are best achieved by co-operation between National TB and AIDS control programmes.

Conclusions: Because chemoprophylaxis for HIV associated TB makes economic and epidemiological sense, large national programmes should be initiated in sub-Saharan Africa. Operational research is necessary to define the best ways to deliver chemoprophylaxis to the majority of the HIV infected persons and to test the cost-effectiveness of chemoprophylaxis in established national programmes.