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2020-09-09
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IMPACT OF ISONIAZID PREVENTIVE THERAPY FOR HIV-INFECTED ADULTS IN RIO DE JANEIRO, BRAZIL: AN EPIDEMIOLOGICAL MODEL
Infectious disease transmission
HIV
Theoretical models
Brazil
Isoniazid
Autor
Afiliación
Johns Hopkins University. School of Medicine. Center for Tuberculosis Research. Baltimore, MA, USA / Johns Hopkins University. Johns Hopkins Bloomberg School of Public Health. Department of Epidemiology. Baltimore, MA, USA.
Johns Hopkins University. School of Medicine. Center for Tuberculosis Research. Baltimore, MA, USA / Johns Hopkins University. Johns Hopkins Bloomberg School of Public Health. Department of Epidemiology. Baltimore, MA, USA.
Municipal Health Secretariat. Rio de Janeiro, RJ, Brazil.
Johns Hopkins University. Johns Hopkins Bloomberg School of Public Health. Department of International Health. Baltimore, MA, USA.
Municipal Health Secretariat. Rio de Janeiro, RJ, Brazil / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Johns Hopkins University. School of Medicine. Center for Tuberculosis Research. Baltimore, MA, USA
Fundação Oswaldo Cruz. Presidência. Programa de Computação Científica. Rio de Janeiro, RJ, Brasil.
Johns Hopkins University. School of Medicine. Center for Tuberculosis Research. Baltimore, MA, USA / Johns Hopkins University. Johns Hopkins Bloomberg School of Public Health. Department of Epidemiology. Baltimore, MA, USA / Johns Hopkins University. Johns Hopkins Bloomberg School of Public Health. Department of International Health. Baltimore, MA, USA.
Municipal Health Secretariat. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Rio de Janeiro, RJ, Brazil.
Johns Hopkins University. School of Medicine. Center for Tuberculosis Research. Baltimore, MA, USA / Johns Hopkins University. Johns Hopkins Bloomberg School of Public Health. Department of Epidemiology. Baltimore, MA, USA.
Municipal Health Secretariat. Rio de Janeiro, RJ, Brazil.
Johns Hopkins University. Johns Hopkins Bloomberg School of Public Health. Department of International Health. Baltimore, MA, USA.
Municipal Health Secretariat. Rio de Janeiro, RJ, Brazil / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Johns Hopkins University. School of Medicine. Center for Tuberculosis Research. Baltimore, MA, USA
Fundação Oswaldo Cruz. Presidência. Programa de Computação Científica. Rio de Janeiro, RJ, Brasil.
Johns Hopkins University. School of Medicine. Center for Tuberculosis Research. Baltimore, MA, USA / Johns Hopkins University. Johns Hopkins Bloomberg School of Public Health. Department of Epidemiology. Baltimore, MA, USA / Johns Hopkins University. Johns Hopkins Bloomberg School of Public Health. Department of International Health. Baltimore, MA, USA.
Municipal Health Secretariat. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Rio de Janeiro, RJ, Brazil.
Resumen en ingles
Background —The potential epidemiological impact of isoniazid preventive therapy (IPT), delivered at levels that could be feasibly scaled up among people living with HIV (PLHIV) in modern, moderate-burden settings, remains uncertain. Methods — We used routine surveillance and implementation data from a cluster-randomized trial of IPT among HIV-infected clinic patients with good access to antiretroviral therapy in Rio de
Janeiro, Brazil, to populate a parsimonious transmission model of TB/HIV. We modeled IPT delivery as a constant process capturing a proportion of the eligible population every year. We projected feasible reductions in tuberculosis (TB) incidence and mortality in the general population and among PLHIV specifically at the end of five years after implementing an IPT program. Results — Data on time to IPT fit an exponential curve well, suggesting that IPT was delivered at a rate covering 20% (95% confidence interval: 16%, 24%) of the 2,500 eligible individuals each year. By the end of year 5 after modeled program roll-out, IPT had reduced TB incidence by 3.0% (95% uncertainty range, UR: 1.6%, 7.2%) in the general population and by 15.6% (95%UR: 15.5%, 36.5%) among PLHIV. Corresponding reductions in TB mortality were 4.0% (95%UR: 2.2%, 10.3%) and 14.3% (14.6%, 33.7%). Results were robust to wide variations in parameter values on sensitivity analysis. Conclusions — TB screening and IPT delivery can substantially reduce TB incidence and mortality among PLHIV in urban, moderate-burden settings. In such settings, IPT can be an important component of a multi-faceted strategy to feasibly reduce the burden of TB in PLHIV.
Palabras clave en ingles
TuberculosisInfectious disease transmission
HIV
Theoretical models
Brazil
Isoniazid
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