An intervention to optimise the delivery of integrated tuberculosis and HIV services at primary care clinics: results of the MERGE cluster randomised trial

Kufa, Tendesayi; Fielding, Katherine; Hippner, Piotr; Kielmann, Karina; Vassall, Anna; Churchyard, Gavin J.; Grant, Alison D.; Charalambous, Salome

doi:10.1016/j.cct.2018.07.013

Cited by 12 publications

(30 citation statements)

References 26 publications

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“…The important losses in the cascade found might be explained by the fragmentation of TB and HIV care. Multiple studies reported that integration of TB and HIV care was an important enabler of TPT [18,38,72,74,76,79,82], while fragmentation of TB and HIV care was identified as an important barrier [34,81]. This suggests that policymakers should work to close the gap between HIV and TB care.…”

Section: Discussionmentioning

confidence: 99%

“…Among cohorts that did not receive LTBI tests, the cumulative TPT initiation and completion were similar if PLHIV were followed at HIV clinics or other clinics (S5 Fig [18,21,24,38,51,58,66,[70][71][72][73][74][75][76]78,79,82]. The most common facilitators were related to the initial steps (identification, initial LTBI testing, and completing LTBI testing) and to initiation and completion of TPT.…”

Section: Plos Medicinementioning

confidence: 96%

“…evaluated for TPT, and 40 (64%) of these cohorts were seen in HIV clinics. Twenty-one cohorts [17,[66][67][68][69][70][71][72][73][74][75][76][77][78][79] did not use LTBI tests, while 49 cohorts used LTBI tests; 22 used only TST, 12 used only IGRA, and 15 used either IGRA or TST. Among the 56 (80%) studies that reported the type of TPT regimen, mono-isoniazid regimens were the primary regimen prescribed in 50 cohorts (89%), and only one (2%) of the included cohorts primarily prescribed rifamycin-based short regimens (3 to months of rifampicin and isoniazid) [29].…”

Section: Plos Medicinementioning

confidence: 99%

“…steps in 7 studies [18,38,72,74,76,79,82]. Barriers were reported by 12 studies [18,21,24,34,58,66,70,72,74,78,80,81], primarily at the initial steps of identification and testing and the final steps of initiating and completing TPT.…”

Section: Plos Medicinementioning

confidence: 99%

“…Pill burden, fear of adverse events, and stocks out of LTBI drugs were also reported as barriers for starting and completing TPT [18,34,72,74,78]. [18,38,72,74,76,79,82] • Fragmentation of care of HIV and TB patients [34,81] • Testing and TPT were implemented by TB programs that were not familiar with the care of HIV patients [66] • Stigma of HIV patients receiving care in TB clinics [72,74] • Lack of information, motivation, and support to HCW [21,80,81] • Too much workload [81] Identification • Participation of staff in the design of TPT implementations strategy [70] • Patient education material [70] • HIV testing for household contacts of infectious TB disease [38,71] • Community HCWs initiating contact [71] • TB/HIV care in antenatal care services [73,75] • Creation of a TB/HIV integration officer and a TB screening officer [76] • Task shifting TB screening to primary care [76] • None Identified Initial testing • Theoretical training on TST [18,24] • TST training [18,24,70] • Extra consultation room [18] • TB screening by "lay counselor" [18] • TB screening done by physicians [24] • TB nurse dedicated for administration of TST [24] • TB counseling at the moment of HIV diagnosis…”

Section: Plos Medicinementioning

confidence: 99%

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The latent tuberculosis cascade-of-care among people living with HIV: A systematic review and meta-analysis

et al. 2021

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Background Tuberculosis preventive therapy (TPT) reduces TB-related morbidity and mortality in people living with HIV (PLHIV). Cascade-of-care analyses help identify gaps and barriers in care and develop targeted solutions. A previous latent tuberculosis infection (LTBI) cascade-of-care analysis showed only 18% of persons in at-risk populations complete TPT, but a similar analysis for TPT among PLHIV has not been completed. We conducted a meta-analysis to provide this evidence. Methods and findings We first screened potential articles from a LTBI cascade-of-care systematic review published in 2016. From this study, we included cohorts that reported a minimum of 25 PLHIV. To identify new cohorts, we used a similar search strategy restricted to PLHIV. The search was conducted in Medline, Embase, Health Star, and LILACS, from January 2014 to February 2021. Two authors independently screened titles and full text and assessed risk of bias using the Newcastle–Ottawa Scale for cohorts and Cochrane Risk of Bias for cluster randomized trials. We meta-analyzed the proportion of PLHIV completing each step of the LTBI cascade-of-care and estimated the cumulative proportion retained. These results were stratified based on cascades-of-care that used or did not use LTBI testing to determine eligibility for TPT. We also performed a narrative synthesis of enablers and barriers of the cascade-of-care identified at different steps of the cascade. A total of 71 cohorts were included, and 70 were meta-analyzed, comprising 94,011 PLHIV. Among the PLHIV included, 35.3% (33,139/94,011) were from the Americas and 29.2% (27,460/94,011) from Africa. Overall, 49.9% (46,903/94,011) from low- and middle-income countries, median age was 38.0 [interquartile range (IQR) 34.0;43.6], and 65.9% (46,328/70,297) were men, 43.6% (29,629/67,947) were treated with antiretroviral therapy (ART), and the median CD4 count was 390 cell/mm3 (IQR 312;458). Among the cohorts that did not use LTBI tests, the cumulative proportion of PLHIV starting and completing TPT were 40.9% (95% CI: 39.3% to 42.7%) and 33.2% (95% CI: 31.6% to 34.9%). Among cohorts that used LTBI tests, the cumulative proportions of PLHIV starting and completing TPT were 60.4% (95% CI: 58.1% to 62.6%) and 41.9% (95% CI:39.6% to 44.2%), respectively. Completion of TPT was not significantly different in high- compared to low- and middle-income countries. Regardless of LTBI test use, substantial losses in the cascade-of-care occurred before treatment initiation. The integration of HIV and TB care was considered an enabler of the cascade-of-care in multiple cohorts. Key limitations of this systematic review are the observational nature of the included studies, potential selection bias in the population selection, only 14 cohorts reported all steps of the cascade-of-care, and barriers/facilitators were not systematically reported in all cohorts. Conclusions Although substantial losses were seen in multiple stages of the cascade-of-care, the cumulative proportion of PLHIV completing TPT was higher than previously reported among other at-risk populations. The use of LTBI testing in PLHIV in low- and middle-income countries was associated with higher proportion of the cohorts initiating TPT and with similar rates of completion of TPT.

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Section: Discussionmentioning

confidence: 99%

Section: Plos Medicinementioning

confidence: 96%

Section: Plos Medicinementioning

confidence: 99%

Section: Plos Medicinementioning

confidence: 99%

Section: Plos Medicinementioning

confidence: 99%

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The latent tuberculosis cascade-of-care among people living with HIV: A systematic review and meta-analysis

et al. 2021

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Rapid systematic review of interventions to improve antenatal screening rates for syphilis, hepatitis B, and HIV in low‐ and middle‐income countries

Harrison,

Lind,

Sawleshwarkar

et al. 2024

Intl J Gynecology & Obste

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BackgroundInfectious diseases including syphilis, HIV, and hepatitis B are major contributors to maternal and neonatal morbidity and mortality worldwide, especially in low‐ and middle‐income countries (LMICs). The World Health Organization has prioritized elimination of vertical transmission of these three diseases.ObjectivesTo rapidly assess the impact of interventions designed to improve antenatal screening rates for syphilis, HIV, and hepatitis B in LMICs and to identify areas for future implementation research.Search StrategyA comprehensive search was conducted across PubMed, Embase, and EconLit, targeting articles published between January 1, 2013, and June 27, 2023.Selection CriteriaWe included quantitative interventional studies in English, involving pregnant adults (15 years or older) from LMICs. Exclusions were studies based in high‐income countries, qualitative studies, or those investigating accuracy of diagnostic methods.Data Collection and AnalysisFrom an initial 5549 potential studies, 27 were finalized for review after various screening stages. Data extraction covered aspects such as study design, intervention details, and outcomes. Findings were qualitatively synthesized within a systems thinking framework.Main ResultsThe interventions assessed varied in terms of geographic locations, health care system levels, and modalities. The review highlighted the effectiveness of interventions such as community health interventions, service quality improvements, and financial incentives.ConclusionsThe study underscores the potential of specific interventions in enhancing antenatal screening rates in LMICs. However, there is a discernible research gap concerning hepatitis B. The findings emphasize the importance of capacity building and health systems strengthening in public health interventions.

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Examining Approaches to Estimate the Prevalence of Catastrophic Costs Due to Tuberculosis from Small-Scale Studies in South Africa

et al. 2020

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Background and Objective In context of the End TB goal of zero tuberculosis (TB)-affected households encountering catastrophic costs due to TB by 2020, the estimation of national prevalence of catastrophic costs due to TB is a priority to inform programme design. We explore approaches to estimate the national prevalence of catastrophic costs due to TB from existing datasets as an alternative to nationally representative surveys. Methods We obtained, standardized and merged three patient-level datasets from existing studies on patient-incurred costs due to TB in South Africa. A deterministic cohort model was developed with the aim of estimating the national prevalence of catastrophic costs, using national data on the prevalence of TB and likelihood of loss to follow-up by income quintile and HIV status. Two approaches were tested to parameterize the model with existing cost data. First, a meta-analysis summarized study-level data by HIV status and income quintile. Second, a regression analysis of patient-level data also included employment status, education level and urbanicity. We summarized findings by type of cost and examined uncertainty around resulting estimates. Results Overall, the median prevalence of catastrophic costs for the meta-analysis and regression approaches were 11% (interquartile range [IQR] 9–13%) and 6% (IQR 5–8%), respectively. Both approaches indicated that the main burden of catastrophic costs falls on the poorest households. An individual-level regression analysis produced lower uncertainty around estimates than a study-level meta-analysis. Conclusions This paper presents a novel application of existing data to estimate the national prevalence of catastrophic costs due to TB. This type of model could be useful for researchers and policy makers looking to inform certain policy decisions; however, some uncertainties remain due to limitations in data availability. There is an urgent need for standardized reporting of cost data and improved guidance on methods to collect income data to improve these estimates going forward.

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An intervention to optimise the delivery of integrated tuberculosis and HIV services at primary care clinics: results of the MERGE cluster randomised trial

Cited by 12 publications

References 26 publications

The latent tuberculosis cascade-of-care among people living with HIV: A systematic review and meta-analysis

The latent tuberculosis cascade-of-care among people living with HIV: A systematic review and meta-analysis

Rapid systematic review of interventions to improve antenatal screening rates for syphilis, hepatitis B, and HIV in low‐ and middle‐income countries

Examining Approaches to Estimate the Prevalence of Catastrophic Costs Due to Tuberculosis from Small-Scale Studies in South Africa

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