There is now strong evidence from several randomized controlled trials for the efficacy of preventive
therapy in the prevention of
tuberculosis in
tuberculin skin test positive persons infected with the human immunodeficiency virus (HIV). The World Health Organization and the International Union Against
Tuberculosis and
Lung Disease recommend preventive
therapy for
tuberculin skin test positive, HIV-infected persons who do not have active
tuberculosis. While implementation of preventive
therapy is manageable in industrialised countries because it is affordable and the infrastructure is in place to screen, treat and monitor patients on a regular basis, its implementation in developing countries presents several problems. Feasibility issues such as identification of large numbers of HIV-infected persons, exclusion of active
tuberculosis, identification of those most likely to benefit, supervision of preventive
therapy and monitoring of
adverse drug reactions need to be resolved before
tuberculosis preventive
therapy can be introduced on a larger scale in developing countries. Possible sites for implementation of a
tuberculosis preventive
therapy service include voluntary counselling and testing centres for HIV and occupational health clinics for military personnel, hospital or company workers. Feasibility studies need to be carried out to address these issues in developing countries.