Services needed before setting up a preventive therapy service

Before a preventive therapy service is considered, the following prerequisites should be in place:

° adequate capacity for HIV counselling,which should include IEC about TB; ° sufficient trained health care staff; ° linkage between HIV care and TB control services; ° good TB control programme with high cure rates and combined default/failure rates at the end of treatment of less than 10%.

Recommendations for a preventive therapy service ° Preventive therapy against TB should be part of a package of care for people living with HIV/AIDS. ° Preventive therapy should be used only in settings where it is possible to exclude active TB and to ensure appropriate monitoring and follow-up.

° Information about TB and preventive therapy should be made available to HIV-positive people.

° Preventive therapy should be provided from within settings that include voluntary counselling and testing (VCT) services for HIV.

° The priority for TB control programmes continues to be the detection and cure of infectious TB cases.

° Procurement and supply of anti-TB drugs must be regulated by national authorities in order to prevent the development of drugresistance.

Steps in the delivery of preventive therapy

Those who have a positive HIV test should receive: counselling on TB

screening for active TB

Ask whether persons have a cough: those with a cough should be screened for TB; those with no cough should have a CXR; if the CXR is normal proceed to next step targeting those most likely to benefit

Preventive therapy is recommended for tuberculin-positive HIV-positive persons who do not have active TB. Sometimes it is not possible to perform tuberculin testing. In these circumstances, HIV-positive persons may still be considered for preventive therapy if they are a) living in high TB prevalence areas b) health care workers c) household contacts of TB patients d) prisoners e) miners provision of preventive therapy to those without active TB

Isoniazid is the recommended drug -5 mg/kg (max. 300mg) given as a daily, self-administered therapy for 6 months. Individuals are seen monthly and receive one month's supply of drugs at each visit monitor for adherence and toxicity

Those who interrupt therapy should be followed up.

The aim is to provide at least 6 months of therapy during a one-year period Stop isoniazid in those who develop symptoms and signs of active TB or hepatitis.

evaluation of outcome

Regularly assess the effectiveness of preventive therapy (attendance, adherence, toxicity, withdrawals, completion of therapy)

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