Strategies for isoniazid preventive therapy in HIV-positive patients who consume alcohol.

WHO guidance to defer isoniazid preventive therapy (IPT) among those with regular alcohol use because of hepatotoxicity concerns may exclude many people living with HIV (PLWH) at high TB risk in these settings.To evaluate hepatotoxicity during TB preventive therapy (TPT) in PLWH who report alcohol use in Uganda over 10 years.We developed a Markov model of latent TB infection, isoniazid preventive therapy (IPT - a type of TPT), and TB disease using data from the Alcohol Drinkers' Exposure to Preventive Therapy for TB (ADEPTT) study. We modeled several treatment scenarios, including no IPT, IPT with liver enzyme monitoring (AST/ALT) during treatment, and IPT with pre-screening using the tuberculin skin test (TST).The no IPT scenario had 230 TB deaths/100,000 population over 10 years, which is more than that seen in any IPT scenario. IPT, even with no monitoring, was preferred over no IPT when population TB disease incidence was >50 in 100,000.For PLWH who report alcohol use in high TB burden settings, IPT should be offered, ideally with regular AST/ALT monitoring. However, even if regular monitoring is not possible, IPT is still preferable to no IPT in almost every modeled scenario..

Prevalence of occupational exposure to HIV among health workers in Northern Uganda.

BACKGROUND: The prevalence of HIV in Gulu district is 10.3%. This poses a high risk of occupational exposure and transmission to health workers in hospitals attending to these patients. The risk of HIV transmission from a patient to a health worker has been shown to be between 0.3% and 0.09% following percutaneous and mucocutaneous exposure respectively. OBJECTIVES: This research aimed at determining the prevalence of occupational exposure to HIV. METHOD: A cross sectional study of health workers in Gulu Regional Referral Hospital and St. Mary's Hospital Lacor, in northern Uganda was conducted to establish the frequency of occupational exposures to human immunodeficiency virus (HIV)-infected body fluids. RESULTS: 108 (46%) respondents were found to have been exposed to potentially infectious body fluids. Needle stick injuries was the commonest route of exposure, with a prevalence of 27.7%, followed by mucosal exposure 19.1%, contact with broken skin (5.5%) and lastly by a cut with sharp objects (5.1%). There is therefore need for more sensitization of health workers on infection control and post exposure prophylaxis for health workers.