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Tuberculosis drug development: ensuring people living with HIV are not left behind.

ABSTRACT: An unprecedented number of new tuberculosis (TB) medications are currently in development, and there will be great pressure to deploy these new drugs among all populations after their efficacy is demonstrated. People living with HIV experience a large burden of TB and have a particularly pressing need for TB treatments that are shorter and less toxic. In addition, all people living with HIV now require antiretroviral therapy during TB treatment. A roadmap of the research, programmatic, and regulatory considerations includes the following: (1) inclusion of people living with HIV early in clinical trials for treatment and prevention using new TB medications, (2) prioritization of key studies of HIV-TB drug interactions and interactions between new TB agents, and (3) optimization of clinical trial infrastructure, laboratory capacity, and drug susceptibility testing.

SUBMITTER: Luetkemeyer AF

PROVIDER: S-EPMC3361323 | biostudies-literature | 2011 Nov

REPOSITORIES: biostudies-literature

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Tuberculosis drug development: ensuring people living with HIV are not left behind.

Luetkemeyer Anne F AF Getahun Haileyesus H Chamie Gabriel G Lienhardt Christian C Havlir Diane V DV

American journal of respiratory and critical care medicine 20110825 10

An unprecedented number of new tuberculosis (TB) medications are currently in development, and there will be great pressure to deploy these new drugs among all populations after their efficacy is demonstrated. People living with HIV experience a large burden of TB and have a particularly pressing need for TB treatments that are shorter and less toxic. In addition, all people living with HIV now require antiretroviral therapy during TB treatment. A roadmap of the research, programmatic, and regul ...[more]

PMID: 21868507

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Project description:INTRODUCTION:Tuberculosis (TB) is a leading cause of mortality among people living with HIV (PLHIV). An invigorated global END TB Strategy seeks to increase efforts in scaling up TB preventive therapy (TPT) as a central intervention for HIV programmes in an effort to contribute to a 90% reduction in TB incidence and 95% reduction in mortality by 2035. TPT in PLHIV should be part of a comprehensive approach to reduce TB transmission, illness and death that also includes TB active case-finding and prompt, effective and timely initiation of anti-TB therapy among PLHIV. However, the use and implementation of preventive strategies has remained deplorably inadequate and today TB prevention among PLHIV has become an urgent priority globally. DISCUSSION:We present a summary of the current and novel TPT regimens, including current evidence of use with antiretroviral regimens (ART). We review challenges and opportunities to scale-up TB prevention within HIV programmes, including the use of differentiated care approaches and demand creation for effective TB/HIV services delivery. TB preventive vaccines and diagnostics, including optimal algorithms, while important topics, are outside of the focus of this commentary. CONCLUSIONS:A number of new tools and strategies to make TPT a standard of care in HIV programmes have become available. The new TPT regimens are safe and effective and can be used with current ART, with attention being paid to potential drug-drug interactions between rifamycins and some classes of antiretrovirals. More research and development is needed to optimize TPT for small children, pregnant women and drug-resistant TB (DR-TB). Effective programmatic scale-up can be supported through context-adapted demand creation strategies and the inclusion of TPT in client-centred services, such as differentiated service delivery (DSD) models. Robust collaboration between the HIV and TB programmes represents a unique opportunity to ensure that TB, a preventable and curable condition, is no longer the number one cause of death in PLHIV.

Project description:Intersectionality pinpoints intersecting factors that empower or oppress people with multiple (dis)advantageous conditions. This study examined intersectional inequity in knowledge, attitudes, and testing related to HIV among adults aged 15 to 49 years in Ethiopia. This study used nationally representative 2016 Ethiopian Demographic Health Survey data. The sample size was 27,261 for knowledge about HIV/AIDS and 25,542 for attitude towards people living with HIV and HIV testing. Triple (dis)advantage groups were based on wealth status, education status, and residence. The triple advantages variables specifically are urban residents, the educated, and those who belong to households of high wealth status, while the triple disadvantages are rural residents, the uneducated, and those who live in poor household wealth rank. A multilevel logistic regression analysis was employed. Adjusted odds ratios (aOR) and confidence intervals (CI) with a P-value ≤ 0.05 were considered statistically significant. Based on descriptive analysis, 27.9% (95% CI: 26.5%, 29.3%) of adults had comprehensive knowledge about HIV/AIDS, 39.8% (95% CI: 37.6, 41.9%) exhibited accepting attitude towards people living with HIV, and 20.4% (95% CI: 19.1%, 21.8%) undergo HIV testing. Comprehensive knowledge about HIV/AIDS, accepting attitude towards people living with HIV, and HIV testing was 47.0%, 75.7%, and 36.1% among those with triple advantages, and 13.9%, 16.0% and 8.7% among those with triple non-advantages, respectively. The odds of having comprehensive knowledge about HIV/AIDS, accepting attitude towards people living with HIV, and HIV testing were about three (aOR = 3.4; 95% CI: 2.76 to 4.21), seven (aOR = 7.3; 95% CI = 5.79 to 9.24) and five (aOR = 4.7; 95% CI:3.60 to 6.10) times higher for triple forms of advantage than triple disadvantages, respectively. The findings of this study imply that Ethiopia will not achieve the proposed targets for HIV/AIDS services unless it prioritises individuals who live under multiple disadvantaged conditions.

Dataset Information

Tuberculosis drug development: ensuring people living with HIV are not left behind.

Publications

Tuberculosis drug development: ensuring people living with HIV are not left behind.

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