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

• Published in: PloS one Vol. 11; no. 4; p. e0153243
• Main Authors: Charles, M Katherine, Lindegren, Mary Lou, Wester, C William, Blevins, Meridith, Sterling, Timothy R, Dung, Nguyen Thi, Dusingize, Jean Claude, Avit-Edi, Divine, Durier, Nicolas, Castelnuovo, Barbara, Nakigozi, Gertrude, Cortes, Claudia P, Ballif, Marie, Fenner, Lukas
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13.04.2016; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Africa; AIDS; AIDS-Related Opportunistic Infections - diagnosis; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - prevention & control; Antiretroviral drugs; Antitubercular Agents - therapeutic use; Asia; Biology and Life Sciences; Caribbean Region; Collaboration; Complications and side effects; Diagnosis; Dosage and administration; Drug therapy; Health aspects; Health care; HIV; HIV Infections - complications; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Income; Infection Control; Infections; Integration; Isoniazid; Isoniazid - therapeutic use; Masks; Medical diagnosis; Medical personnel; Medicine and Health Sciences; Mycobacterium; Occupational health; Patients; People and Places; Poverty; Prevention; Preventive medicine; Screening; Skin tests; Smear; South America; Studies; Therapy; Tuberculin; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis - prevention & control; Workers; World Health Organization; South America; Caribbean Region; Asia; Africa; United States; Switzerland; United Kingdom > UK; United States > US; Tennessee; England; South Africa; Uganda; Chile; Nashville Tennessee
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0153243

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. To assess the implementation of the "Three I's" of TB-control at HIV treatment sites in lower income countries. 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. 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). Implementation of TB screening, IPT provision, and infection control measures was low and variable across regional HIV treatment sites, regardless of integration status.