Tuberculosis preventive therapy in HIV-infected persons: feasibility issues in developing countries

There is now strong evidence from several randomized controlled trials for the efficacy of preventive therapy in the prevention of tuberculosis in tub erculin skin test positive persons infected with the human immunodeficiency virus (HIV). The World Health Organization and the International Union Aga inst Tuberculosis and Lung Disease recommend preventive therapy for tubercu lin skin test positive, HIV-infected persons who do not have active tubercu losis. While implementation of preventive therapy is manageable in industri alised countries because it is affordable and the infrastructure is in plac e to screen, treat and monitor patients on a regular basis, its implementat ion in developing countries presents several problems. Feasibility issues s uch as identification of large numbers of HIV-infected persons, exclusion o f active tuberculosis, identification of those most likely to benefit, supe rvision of preventive therapy and monitoring of adverse drug reactions need to be resolved before tuberculosis preventive therapy can be introduced on a larger scale in developing countries. Possible sites for implementation of a tuberculosis preventive therapy service include voluntary counselling and testing centres for HIV and occupational health clinics for military pe rsonnel, hospital or company workers. Feasibility studies need to be carrie d out to address these issues in developing countries.