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About the Authors:
Kesetebirhan Delele Yirdaw
* E-mail: [email protected]
Affiliation: Clinical Department, Johns Hopkins University TSEHAI Project, Addis Ababa, Ethiopia
Degu Jerene
Affiliation: Clinical Department, Johns Hopkins University TSEHAI Project, Addis Ababa, Ethiopia
Zewdu Gashu
Affiliation: Clinical Department, Johns Hopkins University TSEHAI Project, Addis Ababa, Ethiopia
M. E. Edginton
Affiliation: Center for Operational Research, International Union against Tuberculosis and Lung Disease, Paris, France
Ajay M. V. Kumar
Affiliation: International Union against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
Yohannes Letamo
Affiliation: Health Research and Technology Transfer Support Process, Southern Nations Nationalities and People's Region Health Bureau, Hawassa, Southern Nations Nationalities and People's Region, Ethiopia
Beniam Feleke
Affiliation: Care and treatment branch, TB/HIV unit, Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
Alula M. Teklu
Affiliation: PCM Department, Johns Hopkins University TSEHAI Project, Addis Ababa, Ethiopia
Solomon Zewdu
Affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
Bill Weiss
Affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
Andrea Ruff
Affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
Introduction
The TB/HIV syndemic is a global public health challenge accounting for nearly 25% of all HIV-associated deaths [1]. Of 8.7 million estimated incident tuberculosis (TB) cases in 2011, about 13% were among people living with HIV (PLHIV) [1]. The African region, with 80% of the estimated HIV-infected TB cases, bears the brunt of the epidemic [1]. Ethiopia has the dual distinction of being a high TB burden country with incidence of 277 TB cases per 100,000 people per year [2] as well as a high HIV burden country with adult (15–49) HIV prevalence of 1.5% [3]. The prevalence of HIV among TB patients was estimated at 8% [1].
To reduce the burden of TB among PLHIV, the World Health Organization (WHO) recommends Intensified Case Finding (ICF), Isoniazid Preventive Therapy (IPT), Infection control, and early initiation of antiretroviral therapy (ART) [4]. Of these, ART is the most potent and widely implemented TB preventive intervention among PLHIV [4]. Although anti-retroviral drugs lower the risk of TB through immune reconstitution, the risk remains much higher than in HIV-uninfected individuals despite achievement of good CD4 cell recovery,...