ArticleBMC medicine2016
The timing of tuberculosis after isoniazid preventive therapy among gold miners in South Africa: a prospective cohort study.
Article in BMC medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Breakthrough Tuberculosis in a Large Cohort of People Living With HIV on Preventive Treatment.Tropical medicine & international health : TM & IH · 2026Article
- Safety and Effectiveness of Long-Term Isoniazid Treatment for the Prevention of Tuberculosis in High-Risk Dialysis Patients.Kidney international reports · 2026Article
- Prioritizing persons deprived of liberty in global guidelines for tuberculosis preventive treatment.PLoS medicine · 2023Article
- Breakthrough TB among people living with HIV on TB preventive therapy.Public health action · 2022Article
- Effect of different interventions for latent tuberculosis infections in China: a model-based study.BMC infectious diseases · 2022Article
- Prioritising attributes for tuberculosis preventive treatment regimens: a modelling analysis.BMC medicine · 2022Article
- Effectiveness of a 6-Month Isoniazid on Prevention of Incident Tuberculosis Among People Living with HIV in Eritrea: A Retrospective Cohort Study.Infectious diseases and therapy · 2022Article
- HIV-associated tuberculosis.International journal of STD & AIDS · 2021Article
- Effectiveness of isoniazid preventive therapy on incidence of tuberculosis among HIV-infected adults in programme setting.The Indian journal of medical research · 2020Article
- Cost-effectiveness of post-treatment follow-up examinations and secondary prevention of tuberculosis in a high-incidence setting: a model-based analysis.The Lancet. Global health · 2020Article
- Projected population-wide impact of antiretroviral therapy-linked isoniazid preventive therapy in a high-burden setting.AIDS (London, England) · 2019Article
- TB preventive therapy for people living with HIV: key considerations for scale-up in resource-limited settings.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2018Article
- Tuberculosis control interventions targeted to previously treated people in a high-incidence setting: a modelling study.The Lancet. Global health · 2018Article
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Authors and funding
7 authors.
Funding
Abstract
backgroundThe durability of isoniazid preventive therapy (IPT) in preventing tuberculosis (TB) is limited in high-prevalence settings. The underlying mechanism (reactivation of persistent latent TB or reinfection) is not known. We aimed to investigate the timing of TB incidence during and after IPT and associated risk factors in a very high TB and HIV-prevalence setting, and to compare the observed rate with a modelled estimate of TB incidence rate after IPT due to reinfection.
methodsIn a post-hoc analysis of a cluster-randomized trial of community-wide IPT among South African gold miners, all intervention arm participants that were dispensed IPT for at least one of the intended 9 months were included. An incident TB case was defined as any participant with a positive sputum smear or culture, or with a clinical TB diagnosis assigned by a senior study clinician. Crude TB incidence rates were calculated during and after IPT, overall and by follow-up time. HIV status was not available. Multivariable Cox regression was used to analyse risk factors by follow-up time after IPT. Estimates from a published mathematical model of trial data were used to calculate the average reinfection TB incidence in the first year after IPT.
resultsAmong 18,520 participants (96% male, mean age 41 years, median follow-up 2.1 years), 708 developed TB. The TB incidence rate during the intended IPT period was 1.3/100 person-years (pyrs; 95% confidence interval (CI), 1.0-1.6) and afterwards 2.3/100 pyrs (95% CI, 1.9-2.7). TB incidence increased within 6 months followed by a stable rate over time. There was no evidence for changing risk factors for TB disease over time after miners stopped IPT. The average TB incidence rate attributable to reinfection in the first year was estimated at 1.3/100 pyrs, compared to an observed rate of 2.2/100 pyrs (95% CI, 1.8-2.7).
conclusionsThe durability of protection by IPT was lost within 6-12 months in this setting with a high HIV prevalence and a high annual risk of M. tuberculosis infection. The observed rate was higher than the modelled rate, suggesting that reactivation of persistent latent infection played a role in the rapid return to baseline TB incidence.
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