Feasibility of using tuberculin skin test screening for initiation of 36-month isoniazid preventive therapy in HIV-infected patients in resource-constrained settings.

INTRODUCTION Tuberculin skin test (TST) can be used to identify HIV-infected people who would benefit most from long-term Isoniazid Preventive Therapy (IPT). However, in resource-constrained settings, implementation of TST can be challenging. The objectives of this study were to assess the feasibility of implementing TST for IPT initiation and to estimate the proportion of TST-positive among HIV-positive patients in two high TB- and HIV burden settings. METHODS Two prospective observational cohort studies were conducted under programmatic conditions in Mathare, an urban slum of Nairobi, Kenya, and in rural Shiselweni, Swaziland. HIV-positive adults with negative TB symptomatic screening underwent TST. Those testing positive were started on 36-month IPT. RESULTS Of 897 and 1021 patients screened in Mathare and Shiselweni, 550 and 696, respectively, were included. Median age was 38 years, 67.7% were female and 86.8% were on ART. Among TST-eligible participants, 88.0% (491/558) and 81.8% (694/848) accepted TST and 74.2% (414/558) and 77.1% (654/858) returned for test reading in Mathare and Shiselweni, respectively. TST was positive in 49.8% (95%CI: 44.9-54.6) in Mathare and 33.2% (95%CI: 29.6-36.8) in Shiselweni. 36-month IPT was accepted by 96.1% (198/206) patients in Mathare and 99.5% (216/217) in Shiselweni. IPT implementation at the clinics was managed with no additional staff or extra space. CONCLUSION Implementing TST for IPT initiation was feasible and acceptable in both urban and rural resource-constrained settings. This strategy allows patients who can benefit most to receive long-term IPT and avoids unnecessarily treating a significant number of patients who do not stand to benefit.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.