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

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.

Design and implementation of a global site assessment survey among HIV clinics participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium

“…With work in progress for 11 papers addressing gaps in the literature, IeDEA's 2020 site assessment survey promises to generate more scientific productivity than IeDEA's prior consortium-wide general site assessment surveys [2][3][4] and specialized surveys focused on specific patient populations (e.g., pediatrics, pregnant and postpartum women) [8] and areas of service delivery (e.g., tuberculosis, cancer, mental health disorders, etc.) [9][10][11][12][13][14][15]. Data collected through IeDEA's 2020 site assessment survey are being used in studies addressing the following aims: 1.…”

Design and implementation of a global site assessment survey among HIV clinics participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium

“…With work in progress for 11 papers addressing gaps in the literature, IeDEA's 2020 site assessment survey promises to generate more scientific productivity than IeDEA's prior consortium-wide general site assessment surveys [2][3][4] and specialized surveys focused on specific patient populations (e.g., pediatrics, pregnant and postpartum women) [10] and areas of service delivery (e.g., tuberculosis, cancer, mental health disorders, etc.) [11][12][13][14][15][16][17].…”

Real‐world use and outcomes of dolutegravir‐containing antiretroviral therapy in HIV and tuberculosis co‐infection: a site survey and cohort study in sub‐Saharan Africa

“…For the inclusion criteria, it may be possible that a tuberculosis diagnosis was incorrectly documented. It may also be possible that some patients had drug resistant tuberculosis and were not receiving rifampicin; however, such treatment is often provided off‐site in our setting [ 31 ]. To examine these potential sources of bias, we conducted subgroup analyses limited to those with documentation of HRZE and found that results were consistent with the main analysis.…”