What Works for Women and Girls

TB incidence rates under routine clinical care conditions in 2003 found that HAART resultedin a 65% decline in mortality and the TB incidence rate was lower in the HAART group (Jereneet al., 2006). A study in Thailand also found that antiretroviral treatment was significantlyassociated with reduction in deaths among those on HAART prior to initiating TB treatment(Akksilp et al., 2007).Isoniazid Preventive Therapy, With or Without HAART, Can Reduce the Incidence of TBA number of randomized controlled trials have shown that isoniazid preventive therapy (IPT)can reduce the incidence of active TB disease in people living with HIV (Pape et al., 1993;Hawken et al., 1997; Whalen et al., 1997; Mwinga et al., 1998; Halsey et al., 1998; Gordinet al., 2000 cited in Ayles and Muyoyeta, 2006). A Cochrane review of 11 trials involving8,130 randomized participants showed that IPT reduced the risk of active TB by 33% (Aylesand Muyoyeta, 2006). A recent randomized, double-blind placebo controlled trial in Botswanafound that IPT taken for 36 months was more effective than a 6-month course in significantlyreducing risk of TB incidence in people with HIV (Samandari, 2009). IPT can also significantlyreduce death among people on antiretroviral therapy, compared to those not on IPT. Aretrospective analysis evaluated the impact of IPT on mortality of 3,258 HIV-positive miners inSouth Africa who initiated IPT and found that the mortality rate was significantly lower, witha 53% reduction in mortality among those on IPT than among those who did not receive IPT(Innes et al., 2010).HAART and IPT Used in Conjunction Can Be More Effective than HAART Alone inReducing the Incidence of TBHAART used in conjunction with IPT can significantly reduce the incidence of TB comparedwith HAART alone or IPT alone. A retrospective medical record review of 11,026 HIV-positivepatients who were accessing medical care at 29 public clinics in Rio de Janeiro, Brazil fromSeptember 2003 until September 2005 found that isoniazid preventive therapy offered inconjunction with expanded access to HAART may improve TB control among people withHIV in high burden settings. The study was conducted to determine the rates of TB in patientswho received no HAART or IPT; only HAART; only IPT; or both HAART and IPT. The overallincidence rate of TB incidence was 2.28 cases/100 person-years. The TB incidence amongpatients receiving both IPT and HAART was 0.8 cases/100 person years, with a 76% reductionin risk for developing TB in this group (Golub et al., 2007).Cross-Referral of TB and HIV Screening and More Integrated Treatment and ServicesCan Increase Uptake for BothLinks between TB and HIV treatment must be strengthened (Makombe et al., 2006; Harrieset al., 2009a). Efforts are needed to ensure that those with TB know their HIV status and viceversa. Co-trimoxazole, a broad-spectrum antimicrobial agent that is recommended as primaryprevention against opportunistic infections in people living with HIV, can also reduce the272 CHAPTER 10 PREVENTING, DETECTING AND TREATING CRITICAL CO-INFECTIONS