Browsing by Author "Gray, Diane M."
Now showing 1 - 2 of 2
Results Per Page
Sort Options
- ItemIsoniazid for preventing tuberculosis in HIV-infected children(John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration, 2017) Zunza, Moleen; Gray, Diane M.; Young, Taryn; Cotton, Mark; Zar, Heather J.Background: Tuberculosis (TB) is an important cause of illness and death in HIV‐positive children living in areas of high TB prevalence. We know that isoniazid prophylaxis prevents TB in HIV‐negative children following TB exposure, but there is uncertainty related to its role in TB preventive treatment in HIV‐positive children. Objectives: To summarise the effects of TB preventive treatment versus placebo in HIV‐positive children with no known TB contact on active TB, death, and reported adverse events. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed, Embase and two trial registers up to February 2017. Selection criteria: We included trials of HIV‐positive children with and without known TB exposure, randomized to receive TB preventive treatment or placebo. Data collection and analysis: Two review authors independently used the study selection criteria, assessed risk of bias, and extracted data. We assessed effects using risk, incidence rate and hazard ratios and assessed the certainty of evidence using GRADE. Main results: We included three trials, involving 991 participants, below the age of 13 years, from South Africa and Botswana. Children were randomized to isoniazid prophylaxis or placebo, given daily or three times weekly. The median length of follow‐up ranged from 5.7 to 34 months; some were on antiretroviral therapy (ART). In HIV‐positive children not on ART, isoniazid prophylaxis may reduce the risk of active TB (hazard ratio (HR) 0.31, 95% confidence interval (CI) 0.11 to 0.87; 1 trial, 240 participants, low certainty evidence), and death (HR 0.46, 95% CI 0.22 to 0.95; 1 trial, 240 participants, low certainty evidence). One trial (182 participants) reported number of children with laboratory adverse events, which was similar between the isoniazid prophylaxis and placebo groups. No clinical adverse events were reported. In HIV‐positive children on ART, we do not know if isoniazid prophylaxis reduces the risk of active TB (risk ratio (RR) 0.76, 95% CI 0.50 to 1.14; 3 trials, 737 participants, very low certainty evidence) or death (RR 1.45, 95% CI 0.78 to 2.72; 3 trials, 737 participants, very low certainty evidence). Two trials (714 participants) reported number of clinical adverse events and three trials (795 participants) reported number of laboratory adverse events; for both categories, the number of adverse events were similar between the isoniazid prophylaxis and placebo groups. Authors' conclusions: Isoniazid prophylaxis given to all children diagnosed with HIV may reduce the risk of active TB and death in HIV‐positive children not on ART in studies from Africa. For children on ART, no clear benefit was detected.
- ItemProtecting children in low-income and middle-income countries from COVID-19(BMJ, 2020) Ahmed, Salahuddin; Mvalo, Tisungane; Akech, Samuel; Agweyu, Ambrose; Baker, Kevin; Bar-Zeev, Naor; Campbell, Harry; Checkley, William; Chisti, Mohammod Jobayer; Colbourn, Tim; Cunningham, Steve; Duke, Trevor; English, Mike; Falade, Adegoke G.; Fancourt, Nicholas S. S.; Ginsburg, Amy S.; Graham, Hamish R.; Gray, Diane M.; Gupta, Madhu; Hammitt, Laura; Hesseling, Anneke C.; Hooli, Shubhada; Johnson, Abdul-Wahab B. R.; King, Carina; Kirby, Miles A.; Lanata, Claudio F.; Lufesi, Norman; Mackenzie, Grant A.; McCracken, John P.; Moschovis, Peter P.; Nair, Harish; Oviawe, Osawaru; Pomat, William S.; Santosham, Mathuram; Seddon, James A.; Thahane, Lineo Keneuoe; Wahl, Brian; Van der Zalm, Marieke; Verwey, Charl; Yoshida, Lay-Myint; Zar, Heather J.; Howie, Stephen R. C.; McCollum, Eric D.A saving grace of the COVID-19 pandemic in high-income and upper middle-income countries has been the relative sparing of children. As the disease spreads across low-income and middle-income countries (LMICs), long-standing system vulnerabilities may tragically manifest, and we worry that children will be increasingly impacted, both directly and indirectly. Drawing on our shared child pneumonia experience globally, we highlight these potential impacts on children in LMICs and propose actions for a collective response.