Integrated TB and HIV care for Mozambican children: temporal trends, site-level determinants of performance, and recommendations for improved TB preventive treatment
Abstract Background Pediatric tuberculosis (TB), human immunodeficiency virus (HIV), and TB-HIV co-infection are health problems with evidence-based diagnostic and treatment algorithms that can reduce morbidity and mortality. Implementation and operational barriers affect adherence to guidelines in...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-01-01
|
| Series: | AIDS Research and Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12981-020-00325-9 |
| _version_ | 1818648909727137792 |
|---|---|
| author | W. Chris Buck Hanh Nguyen Mariana Siapka Lopa Basu Jessica Greenberg Cowan Maria Inês De Deus Megan Gleason Ferreira Ferreira Carla Xavier Benedita Jose Criménia Muthemba Beatriz Simione Peter Kerndt |
| author_facet | W. Chris Buck Hanh Nguyen Mariana Siapka Lopa Basu Jessica Greenberg Cowan Maria Inês De Deus Megan Gleason Ferreira Ferreira Carla Xavier Benedita Jose Criménia Muthemba Beatriz Simione Peter Kerndt |
| author_sort | W. Chris Buck |
| collection | DOAJ |
| description | Abstract Background Pediatric tuberculosis (TB), human immunodeficiency virus (HIV), and TB-HIV co-infection are health problems with evidence-based diagnostic and treatment algorithms that can reduce morbidity and mortality. Implementation and operational barriers affect adherence to guidelines in many resource-constrained settings, negatively affecting patient outcomes. This study aimed to assess performance in the pediatric HIV and TB care cascades in Mozambique. Methods A retrospective analysis of routine PEPFAR site-level HIV and TB data from 2012 to 2016 was performed. Patients 0–14 years of age were included. Descriptive statistics were used to report trends in TB and HIV indicators. Linear regression was done to assess associations of site-level variables with performance in the pediatric TB and HIV care cascades using 2016 data. Results Routine HIV testing and cotrimoxazole initiation for co-infected children in the TB program were nearly optimal at 99% and 96% in 2016, respectively. Antiretroviral therapy (ART) initiation was lower at 87%, but steadily improved from 2012 to 2016. From the HIV program, TB screening at the last consultation rose steadily over the study period, reaching 82% in 2016. The percentage of newly enrolled children who received either TB treatment or isoniazid preventive treatment (IPT) also steadily improved in all provinces, but in 2016 was only at 42% nationally. Larger volume sites were significantly more likely to complete the pediatric HIV and TB care cascades in 2016 (p value range 0.05 to < 0.001). Conclusions Mozambique has made significant strides in improving the pediatric care cascades for children with TB and HIV, but there were missed opportunities for TB diagnosis and prevention, with IPT utilization being particularly problematic. Strengthened TB/HIV programming that continues to focus on pediatric ART scale-up while improving delivery of TB preventive therapy, either with IPT or newer rifapentine-based regimens for age-eligible children, is needed. |
| first_indexed | 2024-12-17T01:25:55Z |
| format | Article |
| id | doaj.art-2ff004b0f45e4a748b7068b0a951b737 |
| institution | Directory Open Access Journal |
| issn | 1742-6405 |
| language | English |
| last_indexed | 2024-12-17T01:25:55Z |
| publishDate | 2021-01-01 |
| publisher | BMC |
| record_format | Article |
| series | AIDS Research and Therapy |
| spelling | doaj.art-2ff004b0f45e4a748b7068b0a951b7372022-12-21T22:08:41ZengBMCAIDS Research and Therapy1742-64052021-01-011811910.1186/s12981-020-00325-9Integrated TB and HIV care for Mozambican children: temporal trends, site-level determinants of performance, and recommendations for improved TB preventive treatmentW. Chris Buck0Hanh Nguyen1Mariana Siapka2Lopa Basu3Jessica Greenberg Cowan4Maria Inês De Deus5Megan Gleason6Ferreira Ferreira7Carla Xavier8Benedita Jose9Criménia Muthemba10Beatriz Simione11Peter Kerndt12David Geffen School of Medicine, University of California Los AngelesDavid Geffen School of Medicine, University of California Los AngelesLondon School of Hygiene and Tropical MedicineUnited States Agency for International DevelopmentCenters for Disease Control and PreventionCenters for Disease Control and PreventionUnited States Agency for International DevelopmentUnited States Agency for International DevelopmentCenters for Disease Control and PreventionNational Tuberculosis Control Program, Ministry of HealthNational Tuberculosis Control Program, Ministry of HealthNational HIV Program, Ministry of HealthCenters for Disease Control and PreventionAbstract Background Pediatric tuberculosis (TB), human immunodeficiency virus (HIV), and TB-HIV co-infection are health problems with evidence-based diagnostic and treatment algorithms that can reduce morbidity and mortality. Implementation and operational barriers affect adherence to guidelines in many resource-constrained settings, negatively affecting patient outcomes. This study aimed to assess performance in the pediatric HIV and TB care cascades in Mozambique. Methods A retrospective analysis of routine PEPFAR site-level HIV and TB data from 2012 to 2016 was performed. Patients 0–14 years of age were included. Descriptive statistics were used to report trends in TB and HIV indicators. Linear regression was done to assess associations of site-level variables with performance in the pediatric TB and HIV care cascades using 2016 data. Results Routine HIV testing and cotrimoxazole initiation for co-infected children in the TB program were nearly optimal at 99% and 96% in 2016, respectively. Antiretroviral therapy (ART) initiation was lower at 87%, but steadily improved from 2012 to 2016. From the HIV program, TB screening at the last consultation rose steadily over the study period, reaching 82% in 2016. The percentage of newly enrolled children who received either TB treatment or isoniazid preventive treatment (IPT) also steadily improved in all provinces, but in 2016 was only at 42% nationally. Larger volume sites were significantly more likely to complete the pediatric HIV and TB care cascades in 2016 (p value range 0.05 to < 0.001). Conclusions Mozambique has made significant strides in improving the pediatric care cascades for children with TB and HIV, but there were missed opportunities for TB diagnosis and prevention, with IPT utilization being particularly problematic. Strengthened TB/HIV programming that continues to focus on pediatric ART scale-up while improving delivery of TB preventive therapy, either with IPT or newer rifapentine-based regimens for age-eligible children, is needed.https://doi.org/10.1186/s12981-020-00325-9PediatricChildrenHIVTuberculosisCo-infectionIPT |
| spellingShingle | W. Chris Buck Hanh Nguyen Mariana Siapka Lopa Basu Jessica Greenberg Cowan Maria Inês De Deus Megan Gleason Ferreira Ferreira Carla Xavier Benedita Jose Criménia Muthemba Beatriz Simione Peter Kerndt Integrated TB and HIV care for Mozambican children: temporal trends, site-level determinants of performance, and recommendations for improved TB preventive treatment AIDS Research and Therapy Pediatric Children HIV Tuberculosis Co-infection IPT |
| title | Integrated TB and HIV care for Mozambican children: temporal trends, site-level determinants of performance, and recommendations for improved TB preventive treatment |
| title_full | Integrated TB and HIV care for Mozambican children: temporal trends, site-level determinants of performance, and recommendations for improved TB preventive treatment |
| title_fullStr | Integrated TB and HIV care for Mozambican children: temporal trends, site-level determinants of performance, and recommendations for improved TB preventive treatment |
| title_full_unstemmed | Integrated TB and HIV care for Mozambican children: temporal trends, site-level determinants of performance, and recommendations for improved TB preventive treatment |
| title_short | Integrated TB and HIV care for Mozambican children: temporal trends, site-level determinants of performance, and recommendations for improved TB preventive treatment |
| title_sort | integrated tb and hiv care for mozambican children temporal trends site level determinants of performance and recommendations for improved tb preventive treatment |
| topic | Pediatric Children HIV Tuberculosis Co-infection IPT |
| url | https://doi.org/10.1186/s12981-020-00325-9 |
| work_keys_str_mv | AT wchrisbuck integratedtbandhivcareformozambicanchildrentemporaltrendssiteleveldeterminantsofperformanceandrecommendationsforimprovedtbpreventivetreatment AT hanhnguyen integratedtbandhivcareformozambicanchildrentemporaltrendssiteleveldeterminantsofperformanceandrecommendationsforimprovedtbpreventivetreatment AT marianasiapka integratedtbandhivcareformozambicanchildrentemporaltrendssiteleveldeterminantsofperformanceandrecommendationsforimprovedtbpreventivetreatment AT lopabasu integratedtbandhivcareformozambicanchildrentemporaltrendssiteleveldeterminantsofperformanceandrecommendationsforimprovedtbpreventivetreatment AT jessicagreenbergcowan integratedtbandhivcareformozambicanchildrentemporaltrendssiteleveldeterminantsofperformanceandrecommendationsforimprovedtbpreventivetreatment AT mariainesdedeus integratedtbandhivcareformozambicanchildrentemporaltrendssiteleveldeterminantsofperformanceandrecommendationsforimprovedtbpreventivetreatment AT megangleason integratedtbandhivcareformozambicanchildrentemporaltrendssiteleveldeterminantsofperformanceandrecommendationsforimprovedtbpreventivetreatment AT ferreiraferreira integratedtbandhivcareformozambicanchildrentemporaltrendssiteleveldeterminantsofperformanceandrecommendationsforimprovedtbpreventivetreatment AT carlaxavier integratedtbandhivcareformozambicanchildrentemporaltrendssiteleveldeterminantsofperformanceandrecommendationsforimprovedtbpreventivetreatment AT beneditajose integratedtbandhivcareformozambicanchildrentemporaltrendssiteleveldeterminantsofperformanceandrecommendationsforimprovedtbpreventivetreatment AT crimeniamuthemba integratedtbandhivcareformozambicanchildrentemporaltrendssiteleveldeterminantsofperformanceandrecommendationsforimprovedtbpreventivetreatment AT beatrizsimione integratedtbandhivcareformozambicanchildrentemporaltrendssiteleveldeterminantsofperformanceandrecommendationsforimprovedtbpreventivetreatment AT peterkerndt integratedtbandhivcareformozambicanchildrentemporaltrendssiteleveldeterminantsofperformanceandrecommendationsforimprovedtbpreventivetreatment |