Title

Saturation of tuberculosis preventive therapy among people living with HIV, Mumbai, India

Presenter

Vijaykumar Karanjkar

Authors

V. Karanjkar¹, R. Allam², D. Rathod¹, P. Deshpande³, S. Todmal³, A. Palkar³, S. Wani³, S. Koli³, S. Dande³, M. Goyal³, P. Kannan³, R. Agarwal², M. Nyendek², S. Acharya¹

Institutions

¹Mumbai Districts AIDS Control Society, Mumbai, India, ²U.S Centers for Disease Control and Prevention (CDC), Delhi, India, ³International Training & Education Centre for Health Private Limited, Delhi, India

BACKGROUND: Tuberculosis (TB) is a common opportunistic infection among people living with HIV (PLHIV). India’s National AIDS Control Programme (NACP) recommends six months Isoniazid TB preventive therapy (TPT) for all PLHIV through single window service mechanism at antiretroviral therapy (ART) centres. Interruption of TPT was observed in approximately 40% of those initiated on TPT in other country program settings.
METHODS: ART centre staff from 20 ART centres in Mumbai were trained on four symptom (4S) TB screening and contraindications for TPT initiation among PLHIV. All eligible PLHIV were initiated on Isoniazid (INH) 300 mg with pyridoxine 50 mg for six months. Secondary data from routine program TPT registers was compiled and analysed for TPT initiation and completion rates by age and gender between April 2017 and September 2022. Under program settings, we assessed IPT initiation and completion rates among all PLHIV on ART including children eligible for IPT and described reasons for TPT interruption in Mumbai. We used chi-square to determine if there is association of age group, gender and duration of ART on TPT completion and initiation rates.
RESULTS: 36,808 PLHIV were eligible for TPT. Overall, 78% (28790/36808) were initiated on IPT. Of the 28,790 PLHIV initiated on IPT, the majority, 90% (25930/28790), completed the six-month TPT course. Among 2,860 (10%) who did not complete the course, 40% (1149/2860) defaulted, and TPT was interrupted in 44% (1262/2860) due to medical and adverse events. Among those who stopped TPT, 10% (123/1262) were diagnosed with TB and started on anti-TB treatment, 22% (276/1262) experienced an allergic reaction, 7% (91/1262) experienced side-effects due to INH, 57% (726/1262) PLHIV had discontinued during COVID-1 pandemic and 4% (46/1262) refused to continue TPT. Age, gender, and antiretroviral therapy (ART) status were not significantly (p>0.05) associated with IPT initiation and completion rates.
CONCLUSIONS: We achieved high TPT completion rates in programmatic settings in which ART Centre staff were trained on TPT initiation procedures.