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. 2025 Jun 16;14(6):piaf050.
doi: 10.1093/jpids/piaf050.

Tuberculosis Diagnosis, Treatment, and Prevention Services for Children Living with HIV in Low- and Middle-Income Countries: A Multiregional Site Survey

Katherine Laycock  1 , Karl-Günter Technau  2 , Patricia Lelo  3 , Watsamon Jantarabenjakul  4 , Caroline Yonaba  5 , Jorge Pinto  6 , Michael Menser  7 , Fernanda Maruri  8 , Francesca Odhiambo  9 , Ethel Rambiki  10 , Pélagie Babakazo  11 , Van Lam Nguyen  12 , Madeleine Folquet  13 , Daisy Maria Machado  14 , Nelson Kalema  15 , Guy Muula  16 , Ellen Brazier  17 , Dinh Qui Nguyen  18 , Joycelyn Dame  19 , Marco Tulio Luque  20 , Aggrey Semeere  15 , Brian Eley  21 , Marcel Yotebieng  22 , Azar Kariminia  23 , Vanessa Rouzier  24 , Helen Byakwaga  25 , Olivier Marcy  26 , Leslie A Enane  1   27
Affiliations

Tuberculosis Diagnosis, Treatment, and Prevention Services for Children Living with HIV in Low- and Middle-Income Countries: A Multiregional Site Survey

Katherine Laycock et al. J Pediatric Infect Dis Soc. .

Abstract

Background: Tuberculosis (TB) remains a leading cause of morbidity and mortality for children living with HIV (CLHIV), with gaps in TB screening, diagnostics, management, and TB preventive therapy (TPT). We investigated reported practices in these domains at sites caring for CLHIV in low- and middle-income countries (LMICs) within the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium.

Methods: We implemented a site survey from September 2020 to February 2021, querying pre-pandemic practices. This analysis included sites in LMICs providing care for CLHIV that diagnosed TB in 2019. We analyzed responses using descriptive statistics and assessed regional differences using Fisher's exact or chi-square tests.

Results: Of 238 IeDEA sites, 227 (95%) responded and 135 met the inclusion criteria. Most (90%) reported screening for TB at HIV care enrollment. Access to diagnostics varied significantly by region, including nucleic acid amplification testing (NAAT, range 67-100%), mycobacterial culture (range 43%-83%), and drug susceptibility testing (range 30%-82%) (P < .001). On-site TB treatment was high (90%). Reported stock-outs occurred for isoniazid (23/116, 20%) and other TB medications (11/114, 9.6%, range 0%-33%, P = .008). TPT provision ranged 50%-100% (P < .001). Six months of isoniazid was the most common TPT regimen for children (88%). Shorter TPT regimens were uncommon (0.9%-2.8%), as were regimens for multidrug-resistant TB exposure (4.6%).

Conclusions: Overall reported availability of NAAT and integrated TB/HIV treatment for CLHIV cared for at these IeDEA sites in LMICs is encouraging but varies by context. Heterogeneous implementation gaps remain-particularly for drug susceptibility testing, TPT delivery, and TPT regimens-which may impede TB prevention, management, and successful outcomes for CLHIV, warranting continued close attention over time and as global TB care guidelines and services evolve.

Keywords: HIV; TB; TB preventive therapy; diagnostic access; pediatrics.

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Conflict of interest statement

The authors have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Country Locations of IeDEA Sites Included in this Analysis, by IeDEA Region. Reported Availability of Key Diagnostics (Mycobacterial culture, TB NAAT, and chest X-ray) are Presented by IeDEA Region. Map created using mapchart.net. Abbreviations: IeDEA, International epidemiology Databases to Evaluate AIDS; NAAT, nucleic acid amplification testing; TB, tuberculosis.
See this image and copyright information in PMC

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