Highlights
The IMPROVE trial confirms that inpatient initiation of a one-month daily course of rifapentine and isoniazid (1HP) is non-inferior to outpatient initiation for adults with advanced HIV disease (AHD) and cryptococcal meningitis. Hospital-based initiation achieved a 70 percent success rate in tuberculosis (TB) disease-free survival and treatment completion, compared to 62 percent in the outpatient group. Notably, treatment completion rates were higher in the inpatient group (76 percent vs 66 percent), suggesting that earlier intervention may reduce the risk of loss to follow-up. Safety profiles were comparable between the two strategies, with a lower incidence of grade 4 anemia observed in the inpatient initiation group.
