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

• Published in: PLOS global public health Vol. 2; no. 3; p. e0000180
• Main Authors: Kathrin Zürcher, Samyra R Cox, Marie Ballif, Leslie A Enane, Olivier Marcy, Marcel Yotebieng, Gary Reubenson, Worarat Imsanguan, Larissa Otero, Nishi Suryavanshi, Stephany N Duda, Matthias Egger, Jeffrey A Tornheim, Lukas Fenner, International Epidemiology Databases to Evaluate AIDS (IeDEA)
• Format: Journal Article
• Language: English
• Published: Public Library of Science (PLoS) 01.01.2022
• ISSN: 2767-3375
• DOI: 10.1371/journal.pgph.0000180

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.