Drinkers Intervention to Prevent Tuberculosis (DIPT)

Overview

Tuberculosis is the leading cause of death among persons with HIV worldwide, and HIV-infected drinkers are at very high risk for Tuberculosis (TB) disease and mortality. Six months of isoniazid (INH) preventive therapy (IPT) reduces TB morbidity and mortality by 30-50% above the benefit of antiretroviral therapy (ART). However, INH can be toxic to the liver, and as a result in many high TB/HIV prevalence settings, such as east Africa, heavy drinkers are not offered IPT. Thus, interventions to reduce alcohol use are needed to decrease INH toxicity during IPT among HIV/TB infected drinkers. It is also well established that heavy drinkers have poorer ART adherence, and there is growing evidence of reduced IPT adherence in drinkers. However, interventions to reduce drinking have had a limited impact on ART adherence, and further interventions to increase IPT adherence among HIV/TB infected drinkers are likely needed.

DIPT study gives Isoniazid to alcohol drinkers for TB prevention integrated with incentives to enable a reduction in alcohol use and enhance adherence to INH.

The study aims at;

1. Determine the effectiveness of economic incentives contingent on point-of-care urine ethyl glucuronide (EtG) versus no alcohol incentives to reduce heavy drinking over 6 months, among HIV/TB co-infected adult drinkers receiving IPT
2. Determine the effectiveness of economic incentives contingent on point of care (IsoScreen) INH urine positive tests versus no INH incentives on INH adherence among HIV/TB co-infected adult drinkers.
3. Assess the impact of economic incentives on HIV virologic suppression and explore their mechanisms of action, six months after trial completion.