Abstract
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.
Highlights
Tuberculosis (TB) is the leading cause of death among people living with HIV (PLHIV) [1]
In a multi-regional study conducted in 2012 among 47 antiretroviral therapy (ART) clinics, we showed that only 26% offered integrated HIV-TB services, with large regional disparities [10]
This cross-sectional survey was conducted within the International Epidemiology Databases to Evaluate AIDS (IeDEA, www.iedea.org) network, a large consortium of ART clinics predominantly located in low- and middle-income countries (LMICs) [12,13]
Summary
Tuberculosis (TB) is the leading cause of death among people living with HIV (PLHIV) [1]. There is evidence of an association between HIV and drug-resistant TB; outbreaks involving PLHIV have been well-documented in high HIV burden countries [4,5]. Multidrug-resistant tuberculosis (MDR-TB) challenges global TB control and is associated with high mortality [4]. The integration of HIV and TB services has been identified as a global priority, [8,9] especially in regions where both diseases are widespread, which include sub-Saharan Africa, Asia and Latin America. In a multi-regional study conducted in 2012 among 47 ART clinics, we showed that only 26% offered integrated HIV-TB services, with large regional disparities [10]. A study from Uganda showed that integrated HIV and TB services was associated with reduced mortality compared to clinics with no HIV and TB integration [11]. It is unclear to what extent integrated services included the management of drug-resistant TB, especially MDR-TB, among PLHIV.
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