Integrating services for HIV and multidrug-resistant tuberculosis: A global cross-sectional survey among ART clinics in low- and middle-income countries.
Tuberculosis (TB) is the leading cause of death among PLHIV and multidrug-resistant-TB (MDR-TB) is associated with high mortality. We examined the management for adult PLHIV coinfected with MDR-TB at ART clinics in lower income countries. Between 2019 and 2020, we conducted a cross-sectional survey...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2022-01-01
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| Series: | PLOS Global Public Health |
| Online Access: | https://doi.org/10.1371/journal.pgph.0000180 |
| _version_ | 1827831179332550656 |
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| author | Kathrin Zürcher Samyra R Cox Marie Ballif Leslie A Enane Olivier Marcy Marcel Yotebieng Gary Reubenson Worarat Imsanguan Larissa Otero Nishi Suryavanshi Stephany N Duda Matthias Egger Jeffrey A Tornheim Lukas Fenner International Epidemiology Databases to Evaluate AIDS (IeDEA) |
| author_facet | Kathrin Zürcher Samyra R Cox Marie Ballif Leslie A Enane Olivier Marcy Marcel Yotebieng Gary Reubenson Worarat Imsanguan Larissa Otero Nishi Suryavanshi Stephany N Duda Matthias Egger Jeffrey A Tornheim Lukas Fenner International Epidemiology Databases to Evaluate AIDS (IeDEA) |
| author_sort | Kathrin Zürcher |
| collection | DOAJ |
| description | Tuberculosis (TB) is the leading cause of death among PLHIV and multidrug-resistant-TB (MDR-TB) is associated with high mortality. We examined the management for adult PLHIV coinfected with MDR-TB at ART clinics in lower income countries. Between 2019 and 2020, we conducted a cross-sectional survey at 29 ART clinics in high TB burden countries within the global IeDEA network. We used structured questionnaires to collect clinic-level data on the TB and HIV services and the availability of diagnostic tools and treatment for MDR-TB. Of 29 ART clinics, 25 (86%) were in urban areas and 19 (66%) were tertiary care clinics. Integrated HIV-TB services were reported at 25 (86%) ART clinics for pan-susceptible TB, and 14 (48%) clinics reported full MDR-TB services on-site, i.e. drug susceptibility testing [DST] and MDR-TB treatment. Some form of DST was available on-site at 22 (76%) clinics, while the remainder referred testing off-site. On-site DST for second-line drugs was available at 9 (31%) clinics. MDR-TB treatment was delivered on-site at 15 (52%) clinics, with 10 individualizing treatment based on DST results and five using standardized regimens alone. Bedaquiline was routinely available at 5 (17%) clinics and delamanid at 3 (10%) clinics. Although most ART clinics reported having integrated HIV and TB services, few had fully integrated MDR-TB services. There is a continued need for increased access to diagnostic and treatment options for MDR-TB patients and better integration of MDR-TB services into the HIV care continuum. |
| first_indexed | 2024-03-12T04:40:50Z |
| format | Article |
| id | doaj.art-3d16672ed80b47309cf1cf66f80def82 |
| institution | Directory Open Access Journal |
| issn | 2767-3375 |
| language | English |
| last_indexed | 2024-03-12T04:40:50Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj.art-3d16672ed80b47309cf1cf66f80def822023-09-03T09:42:50ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752022-01-0123e000018010.1371/journal.pgph.0000180Integrating services for HIV and multidrug-resistant tuberculosis: A global cross-sectional survey among ART clinics in low- and middle-income countries.Kathrin ZürcherSamyra R CoxMarie BallifLeslie A EnaneOlivier MarcyMarcel YotebiengGary ReubensonWorarat ImsanguanLarissa OteroNishi SuryavanshiStephany N DudaMatthias EggerJeffrey A TornheimLukas FennerInternational Epidemiology Databases to Evaluate AIDS (IeDEA)Tuberculosis (TB) is the leading cause of death among PLHIV and multidrug-resistant-TB (MDR-TB) is associated with high mortality. We examined the management for adult PLHIV coinfected with MDR-TB at ART clinics in lower income countries. Between 2019 and 2020, we conducted a cross-sectional survey at 29 ART clinics in high TB burden countries within the global IeDEA network. We used structured questionnaires to collect clinic-level data on the TB and HIV services and the availability of diagnostic tools and treatment for MDR-TB. Of 29 ART clinics, 25 (86%) were in urban areas and 19 (66%) were tertiary care clinics. Integrated HIV-TB services were reported at 25 (86%) ART clinics for pan-susceptible TB, and 14 (48%) clinics reported full MDR-TB services on-site, i.e. drug susceptibility testing [DST] and MDR-TB treatment. Some form of DST was available on-site at 22 (76%) clinics, while the remainder referred testing off-site. On-site DST for second-line drugs was available at 9 (31%) clinics. MDR-TB treatment was delivered on-site at 15 (52%) clinics, with 10 individualizing treatment based on DST results and five using standardized regimens alone. Bedaquiline was routinely available at 5 (17%) clinics and delamanid at 3 (10%) clinics. Although most ART clinics reported having integrated HIV and TB services, few had fully integrated MDR-TB services. There is a continued need for increased access to diagnostic and treatment options for MDR-TB patients and better integration of MDR-TB services into the HIV care continuum.https://doi.org/10.1371/journal.pgph.0000180 |
| spellingShingle | Kathrin Zürcher Samyra R Cox Marie Ballif Leslie A Enane Olivier Marcy Marcel Yotebieng Gary Reubenson Worarat Imsanguan Larissa Otero Nishi Suryavanshi Stephany N Duda Matthias Egger Jeffrey A Tornheim Lukas Fenner International Epidemiology Databases to Evaluate AIDS (IeDEA) Integrating services for HIV and multidrug-resistant tuberculosis: A global cross-sectional survey among ART clinics in low- and middle-income countries. PLOS Global Public Health |
| title | Integrating services for HIV and multidrug-resistant tuberculosis: A global cross-sectional survey among ART clinics in low- and middle-income countries. |
| title_full | Integrating services for HIV and multidrug-resistant tuberculosis: A global cross-sectional survey among ART clinics in low- and middle-income countries. |
| title_fullStr | Integrating services for HIV and multidrug-resistant tuberculosis: A global cross-sectional survey among ART clinics in low- and middle-income countries. |
| title_full_unstemmed | Integrating services for HIV and multidrug-resistant tuberculosis: A global cross-sectional survey among ART clinics in low- and middle-income countries. |
| title_short | Integrating services for HIV and multidrug-resistant tuberculosis: A global cross-sectional survey among ART clinics in low- and middle-income countries. |
| title_sort | integrating services for hiv and multidrug resistant tuberculosis a global cross sectional survey among art clinics in low and middle income countries |
| url | https://doi.org/10.1371/journal.pgph.0000180 |
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