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

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

M Katherine Charles  1 , Mary Lou Lindegren  1 , C William Wester  1 , Meridith Blevins  1 , Timothy R Sterling  1 , Nguyen Thi Dung  2 , Jean Claude Dusingize  3 , Divine Avit-Edi  4 , Nicolas Durier  5 , Barbara Castelnuovo  6 , Gertrude Nakigozi  7 , Claudia P Cortes  8 , Marie Ballif  9 , Lukas Fenner  9   10   11 ; International epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration
Collaborators, Affiliations

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

M Katherine Charles et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: Timothy R. Sterling reports past grant support to Vanderbilt University from Pfizer, Bristol Myers Squibb and Virco. Timothy R. Sterling has acted as a consultant to Sanofi-Aventis, is a member of a Data Safety Monitoring Board for Otsuka, and receives royalties from UpToDate for textbook chapters on TB/HIV. All other authors declare that they have no competing interests. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

References

    1. WHO Policy on Collaborative TB/HIV Activities: Guidelines for National Programmes and Other Stakeholders In: Organization WH, editor. WHO Guidelines Approved by the Guidelines Review Committee. Geneva: 2012.
    1. WHO Three I’s meeting: intensified case finding (ICF), isoniazid preventive therapy (IPT), and TB infection control (IC) for people living with HIV. In: Organization WH, editor.; Geneva, Switzerland: WHO; 2008.
    1. WHO. Guidelines for intensified tuberculosis case finding and isoniazid preventive therapy for people living with HIV in resource constrained settings. Geneva: World Health Organization; 2012.
    1. WHO. WHO policy on infection control in health-care facilities, congregate settings and households. Geneva: World Health Organization; 2009. - PubMed
    1. Harris JB, Hatwiinda SM, Randels KM, Chi BH, Kancheya NG, Jham MA, et al. Early lessons from the integration of tuberculosis and HIV services in primary care centers in Lusaka, Zambia. The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease. 2008;12(7):773–9. . - PubMed

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