Preventing tuberculosis among HIV-infected pregnant women in lesotho: The case for rolling out active case finding and isoniazid preventive therapy

Appolinaire Tiam, Rhoderick Machekano, Celine R. Gounder, Llang B.M. Maama-Maime, Keletso Ntene-Sealiete, Maitreyi Sahu, Anthony Isavwa, Oyebola Oyebanji, Allan Ahimbisibwe, Majoalane Mokone, Grace L. Barnes, Richard E. Chaisson, Laura Guay, Seble Kassaye

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The Lesotho Ministry of Health issued guidelines on active case finding (ACF) for tuberculosis (TB) and isoniazid preventive therapy (IPT) in April 2011. ACF has been recommended in maternal and child health (MCH) settings globally, however, the feasibility of implementing IPT within MCH in countries with high concurrent HIV and TB epidemics is unknown. DESIGN/Methods: The study evaluated the implementation of ACF and IPT guidelines in MCH settings in 2 health facilities in Lesotho. This descriptive prospective study analyzed data collected during routine services. Categorical data and continuous variables were summarized using descriptive statistics. The χ test or Wilcoxon rank-sum test was used to ascertain significant associations between categorical and continuous variables, respectively. Results: Data from 160 HIV-positive and 640 HIV-negative women were reviewed. Within this study population, 99.8% of women were screened for TB, and 11.4% HIV-positive women compared with 2.3% HIV-negative women were reported to have symptoms of TB (P < 0.001). IPT was initiated in 124/158 (78.5%) HIV-positive pregnant women, 64.5% women completed a 6-month IPT regimen, 2 (1.6%) died of causes unrelated to IPT/TB, and 31.5% were lost to follow-up. Predictors of IPT initiation among HIV-positive women included gestational age at the first antenatal visit (unadjusted odds ratio,-0.93; 95% confidence interval:-0.88 to 0.98), and receipt of antiretroviral therapy for treatment rather than for prevention of mother-to-child transmission prophylaxis only (odds ratio, 4.59; 95% confidence interval: 1.32 to 15.93). Conclusions: Implementation of ACF and IPT is feasible within the MCH setting. Uptake of IPT during pregnancy among HIV-positive women was high, but with a high rate of loss to follow-up.

Original languageEnglish (US)
Pages (from-to)e5-e11
JournalJournal of acquired immune deficiency syndromes
Volume67
Issue number1
DOIs
StatePublished - Sep 1 2014
Externally publishedYes

Keywords

  • HIV
  • pregnancy
  • prevention
  • therapy

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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