Current approaches to TB control have been hindered by the spread of resistance to existing TB drugs and the epidemic of HIV/TB co-infection. In the face of these challenges, the WHO has recommended the scale-up of isoniazid prevention therapy (IPT) in HIV patients with latent TB infection. While it is hoped this intervention will improve clinical outcomes among HIV patients and help accelerate progress towards TB control targets, there is significant uncertainty surrounding the long-term epidemiologic outcomes of these interventions given current epidemiologic and programmatic conditions, and their impact on drug resistance trends. For instance, Cote d’Ivoire, a country with high burden of HIV/TB coinfection, has yet to implement a policy of IPT due in part to concerns over the emergence of drug resistance, and uncertainty regarding the duration of effect of IPT. In collaboration with one of the largest providers of HIV care in Cote d’Ivoire, we will estimate the risk of TB and outcomes of TB treatment among HIV patients in routine clinical care settings and incorporate these results, along with insights on potential constraints to the implementation of IPT, in a mathematical model of TB transmission to project the population-level impact on TB incidence and drug resistance. The results of these modeling analyses will help guide policy decisions on the implementation of IPT for HIV patients and the general population in Cote d’Ivoire.

Global Health Project Grant Advisor/Mentor: David Dowdy