Integrating services for HIV and multidrug-resistant tuberculosis: A global cross-sectional survey among ART clinics in low- and middle-income countries.

Autor:	Zürcher K; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland., Cox SR; Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America., Ballif M; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland., Enane LA; The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States of America., Marcy O; U1219 Bordeaux Population Health Research Center, University of Bordeaux, Inserm, IRD, Bordeaux, France., Yotebieng M; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America., Reubenson G; Faculty of Health Sciences, Department of Paediatrics and Child Health, University of the Witwatersrand, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa., Imsanguan W; Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand., Otero L; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru., Suryavanshi N; Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.; Johns Hopkins India, Pune, India., Duda SN; Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States of America., Egger M; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa.; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom., Tornheim JA; Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America., Fenner L; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2022; Vol. 2 (3). Date of Electronic Publication: 2022 Mar 01.
DOI:	10.1371/journal.pgph.0000180
Abstrakt:	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. Competing Interests: Competing interests: The authors have declared that no competing interests exist.
Databáze:	MEDLINE
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