What Works for Women and Girls

There is very little sex-disaggregated data on TB/HIV that is not pregnancy-related. As aresult, there are a number of research and program gaps related to what works for women whoare living with both HIV and TB.What Works—Preventing, Detecting and Treating Critical Co-Infections: Tuberculosis1. IPT, as well as HAART, can reduce the incidence of TB.Promising Strategies:2. Screening for TB during routine antenatal care in high HIV prevalent settings resultsin increased TB detection rates in women and is acceptable to most women, thoughstigma may be a barrier.3. Infection control of TB within health care settings can reduce the incidence of TBamong health care workers, particularly nurses.EVIDENCE1. IPT, as well as HAART, can reduce the incidence of TB.A number of randomized controlled trials have shown that isoniazid preventive therapy(IPT) to 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;Gordin et al., 2000 cited in Ayles and Muyoyeta, 2006). (Gray I) (TB, treatment)A Cochrane review of 11 trials involving 8,130 randomized participants showed thatIPT reduced the risk of active TB by 33% (Ayles and Muyoyeta, 2006). (Gray I) (TB,treatment)A recent randomized, double-blind placebo controlled trial in Botswana found that isoniazidpreventive therapy (IPT) taken for 36 months was more effective than a 6-monthcourse in significantly reducing risk of TB incidence in people with HIV (Samandari,2009). (Gray II) (TB, treatment, Botswana)A retrospective analysis evaluated the impact of IPT on mortality of 3,258 HIV-positiveminers in South Africa who initiated IPT and found that the mortality rate was significantlylower, with a 53% reduction in mortality among those on IPT than among thosewho did not receive IPT (Innes et al., 2010). (Gray III) (TB, treatment, South Africa)A study in Ethiopia that assessed the effect of HAAART on patient mortality and TB incidencerates under routine clinical care conditions in 2003 found that HAART resulted274 CHAPTER 10 PREVENTING, DETECTING AND TREATING CRITICAL CO-INFECTIONS