Tuberculosis, injecting drug use and integrated HIV-TB care: a review of the literature

Drug Alcohol Depend. 2013 May 1;129(3):180-209. doi: 10.1016/j.drugalcdep.2012.11.013. Epub 2013 Jan 8.

Abstract

Background: People who inject drugs (PWID) are at increased risk of tuberculosis (TB) and reduced retention in treatment. There is a need to document strategies for integrated delivery of HIV, TB and drug dependency care.

Methods: This article reviews the literature on rates of TB mono- and co-infection, and published and grey literature descriptions of TB and HIV-TB care, among PWID.

Results: Latent TB infection prevalence was high and active disease more common among HIV-positive PWID. Data on multidrug-resistant TB and co-infections among PWID were scarce. Models of TB care fell into six categories: screening and prevention within HIV-risk studies; prevention at TB clinics; screening and prevention within needle-and-syringe-exchange (NSP) and drug treatment programmes; pharmacy-based TB treatment; TB service-led care with harm reduction/drug treatment programmes; and TB treatment within drug treatment programmes. Co-location with NSP and opioid substitution therapy (OST), combined with incentives, consistently improved screening and prevention uptake. Small-scale combined TB treatment and OST achieved good adherence in diverse settings. Successful interventions involved collaboration across services; a client-centred approach; and provision of social care. No peer-reviewed studies described models of integrated HIV-TB care for PWID but grey literature highlighted key components: co-located services, provision of drug treatment, multidisciplinary staff training; and remaining barriers: staffing inefficiencies, inadequate funding, police interference, and limited OST availability.

Conclusions: Integration with drug treatment improves PWID engagement in TB services but there is a need to document approaches to HIV-TB care, improve surveillance of TB and co-infections among PWID, and advocate for improved OST availability.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • HIV Infections / epidemiology*
  • HIV Infections / therapy*
  • Humans
  • Needle-Exchange Programs / methods
  • Substance Abuse, Intravenous / epidemiology*
  • Substance Abuse, Intravenous / therapy*
  • Tuberculosis / epidemiology*
  • Tuberculosis / therapy*