Pilot Award

The dual pandemics of tuberculosis (TB) and human immunodeficiency virus (HIV) have coincided in sub-Saharan Africa. Kenya is a clear example of this situation with high regional HIV prevalence (as high as 17.4%) and highly endemic TB with an annual case rate of 329 per 100,000 people. Children have not been immune from the rise of these pandemics. In Kenya an estimated 200,000 children are HIV-infected and between 10-20% may be co-infected with TB. Children with HIV have 20 times the risk of TB and co-infected children face 3-6 fold increased mortality. There is clearly an urgent need to enhance prevention of TB co-infection. The use of isoniazid as prophylaxis to prevent TB may be an effective strategy to improve outcomes of HIV-infected children in this setting. This study is a prospective cohort study with time-series design to establish TB incidence and determine the effect of isoniazid preventive therapy (IPT) in HIV-infected children in Kenya. The study will be conducted in two phases. The pilot phase will be performed to evaluate the optimal approach to TB screening in HIV-infected children in a low-resource setting and to establish the incidence of TB in this group using traditional TB screening methods such as chest X-ray, TB scoring charts and tuberculin skin testing. In the second phase participants will receive isoniazid for one year and the effect of IPT on all cause mortality, morbidity and TB incidence will be assessed.