Implementation of Tuberculosis Intensive Case Finding, Isoniazid Preventive Therapy, and Infection Control ("Three I's") and HIV-Tuberculosis Service Integration in Lower Income Countries

PLoS One. 2016 Apr 13;11(4):e0153243. doi: 10.1371/journal.pone.0153243. eCollection 2016.

Abstract

Setting: World Health Organization advocates for integration of HIV-tuberculosis (TB) services and recommends intensive case finding (ICF), isoniazid preventive therapy (IPT), and infection control ("Three I's") for TB prevention and control among persons living with HIV.

Objective: To assess the implementation of the "Three I's" of TB-control at HIV treatment sites in lower income countries.

Design: Survey conducted between March-July, 2012 at 47 sites in 26 countries: 6 (13%) Asia Pacific, 7 (15%), Caribbean, Central and South America, 5 (10%) Central Africa, 8 (17%) East Africa, 14 (30%) Southern Africa, and 7 (15%) West Africa.

Results: ICF using symptom-based screening was performed at 38% of sites; 45% of sites used symptom-screening plus additional diagnostics. IPT at enrollment or ART initiation was implemented in only 17% of sites, with 9% of sites providing IPT to tuberculin-skin-test positive patients. Infection control measures varied: 62% of sites separated smear-positive patients, and healthcare workers used masks at 57% of sites. Only 12 (26%) sites integrated HIV-TB services. Integration was not associated with implementation of TB prevention measures except for IPT provision at enrollment (42% integrated vs. 9% non-integrated; p = 0.03).

Conclusions: Implementation of TB screening, IPT provision, and infection control measures was low and variable across regional HIV treatment sites, regardless of integration status.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • AIDS-Related Opportunistic Infections / diagnosis*
  • AIDS-Related Opportunistic Infections / drug therapy
  • AIDS-Related Opportunistic Infections / prevention & control*
  • Africa
  • Antitubercular Agents / therapeutic use*
  • Asia
  • Caribbean Region
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • Humans
  • Infection Control*
  • Isoniazid / therapeutic use*
  • Poverty
  • South America
  • Tuberculosis / diagnosis*
  • Tuberculosis / drug therapy
  • Tuberculosis / prevention & control*
  • World Health Organization

Substances

  • Antitubercular Agents
  • Isoniazid