Collaborative tuberculosis/HIV activities in the European Region

Abstract

IntroductionAn estimated 12% of tuberculosis (TB) patients are coinfected with HIV in the World Health Organisation European Region (Region). Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with integrated people-centred models of care.MethodsWe collected information on the current models of integration of TB and HIV services in the Region via a comprehensive survey among the TB and HIV National Focal Points, and identified challenges and opportunities.ResultsForty-seven of 55 countries (85%) responded. HIV testing in all TB patients and screening for active TB in all people living with HIV (PLHIV) was recommended in 40 (85%) and 34 (72%) respectively. Thirty countries (64%) recommended latent TB infection (LTBI) screening in all PLHIV, while 13 (28%) had a selective approach and 4 countries (9%) did not recommend LTBI screening. In most countries testing for HIV and screening for active TB and LTBI was done by the specialist that is treating the patient, i.e. TB patients were tested for HIV by a TB specialist in 42 countries (89%) and PLHIV were screened for active TB by an HIV specialist in 34 countries (72%).ConclusionTB and HIV care are well integrated in policies of especially high TB and high HIV burden countries. Implementation though needs to be improved. Continuous monitoring of HIV and TB services integration enables assessing the quality of HIV/TB care and to identify where further improvements are needed.

Improving healthcare for patients with HIV, tuberculosis and hepatitis C in eastern Europe: a review of current challenges and important next steps

“…In the vast majority (79%), care was initiated at special TB hospitals [39]. The testing of all TB patients for HIV was recommended in 85%, while the screening for active TB in all PLWH was recommended in 72% of official national guidelines across Europe [71]. Furthermore, a majority of countries (64%) recommended latent TB infection (LTBI) screening in all PLWH [71].…”

“…The testing of all TB patients for HIV was recommended in 85%, while the screening for active TB in all PLWH was recommended in 72% of official national guidelines across Europe [71]. Furthermore, a majority of countries (64%) recommended latent TB infection (LTBI) screening in all PLWH [71]. Provision of care was standardized by relying on national guidelines in all healthcare centres surveyed in eastern Europe, while only 57% of those centres also relied on WHO or European AIDS clinical society guidelines [39].…”

“…A recent review of person‐centred care in eastern Europe and central Asia claims that diagnosis and care for TB, HIV and viral hepatitis are separate vertical structures in most countries and therefore need increased political and operational integration to bring them closer to patients [12]. However, for most countries in eastern Europe it is not systematically described what models and attempts at integration are applied [71].…”

Practices and attitudes towards tuberculosis and latent tuberculosis infection screening in people living with HIV/AIDS among HIV physicians in Japan

“…Thus, guidelines in low-incidence countries have varied in their recommendations—for example, in a multi-country study on TB/HIV collaborative policies in European countries, in which 47 countries participated, it was reported that 21 (62%) recommended screening all PLHIV for TB, while 13 (38%) recommended selective screening. The criteria for selective screening included previous contact with a TB case, TB symptoms, previous history of TB and low CD4+ cell count (< 350 cells/μL) [ 19 ]. The most recent guideline from the European AIDS Clinical Society has recommended routine screening using chest X-ray (CXR) for PLHIV from high TB prevalence populations [ 13 ].…”

The Russo-Ukrainian war crisis and vaccination of Ukrainian refugees as an urgent need

“… 4 The European Centre for Disease Prevention and Control (ECDC) also notes that other concerns regarding Ukraine's population including (second highest number of tuberculosis cases in Europe), HIV (the second-highest prevalence of HIV/TB coinfection in the World Health Organization European Region), and seasonal flu in Ukraine. 8 , 9 It also announced that traumatic wounds infected by multi-drug resistant organism during the invasion of Ukraine that could be transmitted in other European territories. 10 In summary, the recent Russo-Ukrainian war has raised concern about preventive measures about COVID-19 pandemic.…”