PREVENTIVE CHEMOTHERAPY FOR HIV-ASSOCIATED TUBERCULOSIS IN UGANDA - AN OPERATIONAL ASSESSMENT AT A VOLUNTARY COUNSELING AND TESTING CENTER

Objective: To assess the operational aspects of isoniazid preventive c hemotherapy (IPT) for tuberculosis in persons dually infected with HIV and Mycobacterium tuberculosis identified at an independent HIV volun tary counselling and testing centre in Kampala, Uganda. Design: HIV-in fected persons were counselled, had active tuberculosis excluded by me dical examination, and were offered purified protein derivative (PPD) skin testing. PPD-positive persons were offered isoniazid 300 mg daily for 6 months. Drugs were supplied, and toxicity and compliance were a ssessed monthly. Utilization of service, cost, and sustainability were also assessed. Results: Between 14 June 1991 and 30 September 1992, 9 862 persons tested HIV-positive. Of 5594 HIV-infected clients who retu rned to collect test results, only 1524 (27%) were enrolled. Of those, 1344 were tuberculin-tested (88%); 180 were not tested because of act ive tuberculosis, serious illnesses, refusal, and other reasons. Of th e 1344, 250 (19%) did not return for test reading and 515 were negativ e (47% of tests read). Of 579 tuberculin-positive persons, 59 (10%) we re excluded from preventive chemotherapy because of tuberculosis and o ther respiratory illnesses. Of 520 persons given isoniazid, 62% collec ted at least 80% of their drug supplies. No major toxicity was observe d. One case of tuberculosis occurred in the first month of treatment. Cost of HIV counselling and testing was US$18.54 per person and cost o f follow-up counselling and social support was US$ 7.89. Conclusions: Important factors were identified which caused attrition, such as limi ted motivation by counsellors to discuss tuberculosis issues during HI V pre- and post-test counselling, insufficient availability of medical screening, shifting of sites to collect pills, and frequent tuberculi n-negative tests. Active tuberculosis among 6% of persons screened sug gests that voluntary counselling and testing sites may be important fo r tuberculosis case finding and underscores the need to exclude tuberc ulosis carefully before starting IPT. In developing countries, further studies assessing the feasibility of IPT with in tuberculosis and HIV /AIDS programme conditions are needed. Cost-effectiveness of IPT, comp ared with passive case finding, and its sustainability should be asses sed before national policies are established.