Ineffective alternative
Besides BCG vaccination, another preventive control measure practised widely in North America but largely ignored in developing countries, is isoniazid preventive therapy (IPT). Unfortunately, the impact of this measure on TB is as uncertain.
The recent epidemic of HIV-associated TB in countries in sub-Saharan Africa had led to proposals for studying the use of IPT in these regions. There have been two notable findings since: IPT is effective in preventing TB in co-infected persons and the feasibility of IPT programmes in developing countries is questionable.
Last year, the World Health Organization had cau- tioned against the incorporation of IPT in national TB programmes. Furthermore, IPT could prove to be expensive for developing countries, many of whose per capita health budget is as little as US $4; a recent study in Uganda estimated the cost per person completing the six- month course of IPT therapy to be US $18.
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