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

Publication

Author(s):

Charles MK, Lindegren ML, Wester CW, Blevins M, Sterling TR, Dung NT, Dusingize JC, Avit-Edi D, Durier N, Castelnuovo B, Nakigozi G, Cortes CP, Ballif M, Fenner L; International epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration.

Pub Title:

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

Pub Date:

Apr 13 2016

Journal:

Title: 
PLoS One
Link: 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830552/

PubMed: 27073928
Pub PDF:

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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Citation:

PLoS One. 2016; 11(4): e0153243. Published online 2016 Apr 13. 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 and International epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration¶