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A total of 1,016 of 1,655 men included in the analysis attended the clinic at least once. Six hundred seventy-nine (97 percent) of 702 men eligible to start primary isoniazid preventive therapy did so. The researchers found that the tuberculosis incidence rate before vs. after clinic enrollment was 11.9 vs. 9.0 per 100 person-years, respectively (incidence rate ratio [IRR] after adjustment for calendar period, 0.68 [32 percent reduced incidence]). In further analysis adjusting for calendar period, age, and silicosis grade, the tuberculosis IRR for clinic enrollment was 0.62 (38 percent reduced incidence). In analysis excluding individuals with a history of tuberculosis (and, hence, ineligible for isoniazid preventive therapy), the adjusted IRR for clinic enrollment was 0.54 (46 percent reduced incidence).

"Despite our intervention, the TB incidence rate in the postclinic phase remained unacceptably high at 9 per 100 person-years," the authors write.

"Additional interventions such as secondary preventive therapy and antiretroviral therapy [which is now being rolled out among the workforce] are required to reduce the very high residual morbidity attributable to TB in this community. Further work is needed to determine how best to use available interventions to minimize TB morbidity in areas where both HIV and TB are highly prevalent," the researchers conclude.

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Contact: Alison D. Grant, M.B.B.S., Ph.D.
alison.grant@lshtm.ac.uk
JAMA and Archives Journals
7-Jun-2005