44th Union World Conference on Lung Health: TB-HIV Highlights, Sunday — In Progress

The two key HIV-TB issues explored on Sunday involved Human Rights issues related to TB, and treatment and prevention of TB in pregnant women, children and adolescents living with HIV.

Programme in Kenya reports very high rates of treatment completion of isoniazid preventive therapy (IPT) are possible in children living with HIV and plans to scale up to adults now as well

IMG_5644Dr E Masini of the National TB Programme in Kenya, reported the results of a retrospective review of patient records in three HIV care clinics in Eastern Province, Kenya which piloted administering six months of IPT to 779 HIV-positive children (although children with a record of poor adherence on ART were excluded). The treatment completion rates were high: 556 (91.7%) completed IPT taking all of the doses for 6 months; a further 20 (3.3%) completed IPT after their duration was extended beyond 6 months to compensate for minor treatment interruptions.

Notably, even though the programme used the WHO symptom screen to rule out TB (and also excluded administering IPT to any child who had a history exposure to a person with TB), 18 cases of confirmed or clinically diagnosed TB were detected later by rescreening (as recommended by WHO policy) — generally within the first few weeks on IPT — suggesting that care providers must continue to keep a close eye out for TB symptoms and continue screening for TB symptoms while on IPT treatment, as TB can emerge rapidly in children.

Note —no isoniazid drug resistance was found in the drug sensitivity tests of the four (culture confirmed) cases of TB.

Based on the great results from this study, Kenya is planning to scale up IPT starting with 200,000 (adults and children) in 2014.

Challenges on how best to integrate active TB case finding and IPT with antenatal services and more operational research needed

Dr Amita Gupta spoke on why TB screening and preventive care in pregnant women living with HIV is critical — but there may be low case detection, problems convincing medical staff to administer IPT, and operational challenges in effectively implementing the policy. More implementation science research is desperately needed.

A small study from India reported depressingly poor outcomes reported in adolescents coinfected with HIV and MDR-TB

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