Philanjalo CDC Grant Application, FOA CDC-RFA-GH-11-005Project Abstract'Improving Isoniazid Preventive Therapy Penetration among HIV infected Individualsthrough Intensification of Case Finding at the Community Level in Rural South Africa' South Africa's raging HIV epidemic has resulted in tuberculosis (TB) rates that arenearly three hundred times the levels in the United States. South Africa has the largestglobal burden of HIV/TB coinfection and among the highest rates of drug resistant TB,with consequent high rates of morbidity and mortality that have severe consequences forTB control and antiretroviral therapy roll out programs. The World Health Organizationhas promoted the '3Is' for TB control: 1) intensive case finding (ICF), 2) infectioncontrol and 3) isoniazid preventive therapy (IPT), and has strongly recommendedimplementation of IPT for HIV positive individuals with latent TB infection (LTBI) aspart of a comprehensive package of services to control TB. The uptake of IPT to date hasbeen poor and new strategies with careful evaluation are critically needed. ICF programscan increase active TB case detection and when integrated with HIV case finding can alsopotentially detect out of care HIV positive patients eligible for IPT and thereby increaseIPT uptake. This integrated strategy of IPT nested within a community based ICFprogram combines 2 of the 3 I's in an innovative manner, has not been studied, and holdspromise of reducing TB morbidity and mortality and decreasing TB transmission, amongHIV infected individuals. We propose such a model strategy of IPT, nested into a largercommunity based HIV and TB intensive case finding (ICF) program developed and beingimplemented and evaluated by Philanjalo and Yale University in a rural, resource limitedsetting with among the highest rates of TB and HIV in the world. This operational research proposal aims to demonstrate the feasibility of integratingand to provide new knowledge regarding two innovative TB control strategies to identifyeligible HIV infected individuals for IPT, link these patients to clinical care, and facilitatesuccessful both TB preventive therapy and HIV care and treatment. The effectiveness ofthese linked community-based ICF and IPT strategies will be measured by the followingprimary outcomes: 1) uptake of IPT among HIV+ individuals diagnosed through the ICFmodel 2) initiation, adherence and completion of a 6 month IPT regimen 3) entry into andmonitoring of HIV care 4) determine the cost effectiveness of such a strategy and 5)provide empiric data to enable mathematical modeling of the strategy's impact on thestudy population and beyond. This project is of great public health importance and willbe conducted by Philanjalo, in collaboration with the South African KwaZulu Natalprovincial Department of Health, and Yale University.

Public Health Relevance

Philanjalo CDC Grant Application, FOA CDC-RFA-GH-11-005 NARRATIVE Intensive Case Finding and Isoniazid preventive treatment (IPT) are promoted by the World Health Organization as essential strategies for TB control, but the uptake has been poor. This proposal expands access to IPT among those newly diagnosed with HIV and otherwise not engaged in health care by utilizing a community-based ICF platform in a resource limited setting in rural South Africa. Philanjalo, a South African organization with a decade of experience in operations research, in collaboration with Yale University and University of KwaZulu Natal will conduct this study to determine optimal operational techniques, cost effectiveness of such an expansion strategy, and impact on TB incidence through mathematical modeling.

National Institute of Health (NIH)
Coordinating Office of Global Health (COGH)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZGH1-SRC (99))
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Tugela Ferry
South Africa
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