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de Lima LV, Pavinati G, Bossonario PA, Monroe AA, Pelissari DM, Alves KBA, Magnabosco GT. Clusters of heterogeneity of tuberculosis-HIV coinfection in Brazil: a geospatial study. Rev Saude Publica 2024; 58:10. [PMID: 38656045 PMCID: PMC11037911 DOI: 10.11606/s1518-8787.2024058005531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/23/2023] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE To analyze the geospatialization of tuberculosis-HIV coinfection in Brazil, from 2010 to 2021, and the correlation with socioeconomic, housing, and health indicators. METHODS An ecological study of Brazilian municipalities and states, with data from HIV and tuberculosis information systems, previously reported by the Ministry of Health. The crude and smoothed coefficients were calculated by the local empirical Bayesian method of incidence of coinfection per 100,000 inhabitants in the population aged between 18 and 59 years. Univariate (identification of clusters) and bivariate (correlation with 20 indicators) Moran's indices were used. RESULTS A total of 122,223 cases of coinfection were registered in Brazil from 2010 to 2021, with a mean coefficient of 8.30/100,000. The South (11.44/100,000) and North (9.93/100,000) regions concentrated the highest burden of infections. The coefficients dropped in Brazil, in all regions, in the years of covid-19 (2020 and 2021). The highest coefficients were observed in the municipalities of the states of Rio Grande do Sul, Mato Grosso do Sul, and Amazonas, with high-high clusters in the capitals, border regions, coast of the country. The municipalities belonging to the states of Minas Gerais, Bahia, Paraná, and Piauí showed low-low clusters. There was a direct correlation with human development indices and aids rates, as well as an indirect correlation with the proportion of poor or of those vulnerable to poverty and the Gini index. CONCLUSIONS The spatial analysis of tuberculosis-HIV coinfection showed heterogeneity in the Brazilian territory and constant behavior throughout the period, revealing clusters with high-burden municipalities, especially in large urban centers and in states with a high occurrence of HIV and/or tuberculosis. These findings, in addition to alerting to the effects of the covid-19 pandemic, can incorporate strategic planning for the control of coinfection, aiming to eliminate these infections as public health problems by 2030.
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Affiliation(s)
- Lucas Vinícius de Lima
- Universidade Estadual de MaringáPrograma de Pós-Graduação em EnfermagemMaringáPRBrazil Universidade Estadual de Maringá. Programa de Pós-Graduação em Enfermagem. Maringá, PR, Brazil
| | - Gabriel Pavinati
- Universidade Estadual de MaringáPrograma de Pós-Graduação em EnfermagemMaringáPRBrazil Universidade Estadual de Maringá. Programa de Pós-Graduação em Enfermagem. Maringá, PR, Brazil
| | - Pedro Augusto Bossonario
- Universidade de São PauloPrograma de Pós-Graduação Enfermagem em Saúde PúblicaRibeirão PretoSPBrazil Universidade de São Paulo. Programa de Pós-Graduação Enfermagem em Saúde Pública. Ribeirão Preto, SP, Brazil
| | - Aline Aparecida Monroe
- Universidade de São PauloPrograma de Pós-Graduação Enfermagem em Saúde PúblicaRibeirão PretoSPBrazil Universidade de São Paulo. Programa de Pós-Graduação Enfermagem em Saúde Pública. Ribeirão Preto, SP, Brazil
| | - Daniele Maria Pelissari
- Brazilian Ministry of HealthDepartamento de HIV/aids, Tuberculose, Hepatites Virais e Infecções Sexualmente TransmissíveisBrasíliaDFBrazil Brazilian Ministry of Health. Departamento de HIV/aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis. Brasília, DF, Brazil
| | - Kleydson Bonfim Andrade Alves
- Pan American Health OrganizationDepartment of Communicable Diseases and Environmental Determinants of HealthBrasíliaDFBrazil Pan American Health Organization. Department of Communicable Diseases and Environmental Determinants of Health. Brasília, DF, Brazil
| | - Gabriela Tavares Magnabosco
- Universidade Estadual de MaringáPrograma de Pós-Graduação em EnfermagemMaringáPRBrazil Universidade Estadual de Maringá. Programa de Pós-Graduação em Enfermagem. Maringá, PR, Brazil
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Ogunshola F, Khan R, Ghebremichael M. The Prognosis for Delayed Immune Recovery in HIV-Infected Children might be Associated with Pre-cART CD4 + T cell Count Irrespective of Co-Infection with Tuberculosis. RESEARCH SQUARE 2024:rs.3.rs-4243586. [PMID: 38699317 PMCID: PMC11065074 DOI: 10.21203/rs.3.rs-4243586/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background : Immune reconstitution following the initiation of combination antiretroviral therapy (cART) significantly impacts the prognosis of individuals infected with human immunodeficiency virus (HIV). Our previous studies have indicated that the baseline CD4 + T cells count and percentage before cART initiation are predictors of immune recovery in TB-negative children infected with HIV, with TB co-infection potentially causing a delay in immune recovery. However, it remains unclear whether these predictors consistently impact immune reconstitution during long-term intensive cART treatment in TB-negative/positive children infected with HIV. Results : We confirmed that the baseline CD4 + T cell count is a significant predictor of immune recovery following long-term intensive cART treatment among children aged 5 to 18 years. Children with lower CD4 + T cell count prior cART initiation did not show substantial immunological recovery during the follow-up period. Interestingly, children who were co-infected with TB and had higher baseline CD4 + T cell count eventually achieved good immunological recovery comparable to the TB-negative HIV-infected children. Hence, the baseline CD4 + T cell count at the onset of treatment serves as a reliable predictor of immunological reconstitution in HIV-infected children with or without TB co-infection. Taken together, this follow-up study validates our previous findings and further establishes that initiating cART early alongside early HIV testing can help prevent the diminished CD4 + T cell count associated with inadequate immunological reconstitution.
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Obeagu EI, Obeagu GU, Ubosi NI, Uzoma IC, Tayrab EMA. Concurrent management of HIV and malaria: A comprehensive review of strategies to enhance quality of life. Medicine (Baltimore) 2024; 103:e37649. [PMID: 38579091 PMCID: PMC10994515 DOI: 10.1097/md.0000000000037649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/27/2024] [Indexed: 04/07/2024] Open
Abstract
The co-occurrence of human immunodeficiency virus and malaria presents a complex medical scenario, significantly impacting the quality of life for affected individuals. This comprehensive review synthesizes current knowledge, challenges, and strategies concerning the concurrent management of these infections to improve overall well-being. Epidemiological insights reveal the prevalence and demographic trends, highlighting geographical areas of concern and socioeconomic factors contributing to the burden of co-infection. Pathophysiological interactions elucidate the compounding effects, altering disease progression and treatment outcomes. Healthcare challenges underscore the necessity for integrated care models, evaluating existing healthcare frameworks and their efficacy in addressing dual infections. In-depth analysis of interventions explores pharmacological, behavioral, and preventive measures, evaluating their efficacy and safety in co-infected individuals. Additionally, the review assesses psychosocial support mechanisms, emphasizing community-based interventions and peer networks in enhancing holistic care. Consideration is given to the role of antiretroviral therapy, malaria prevention strategies, and the evolving landscape of healthcare delivery in optimizing outcomes for this vulnerable population. The paper concludes by emphasizing the significance of multidisciplinary approaches and integrated care models, stressing the need for continued research and collaborative efforts to advance interventions and improve the quality of life for those navigating the complexities of human immunodeficiency virus and malaria co-infection.
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Affiliation(s)
| | | | - Nwanganga Ihuoma Ubosi
- Department of Medical Laboratory Science, Kampala International University, Kampala, Uganda
- Department of Public Health Sciences, Faculty of Health Sciences, National Open University of Nigeria, Jabi, Abuja, Nigeria
| | - Ijeoma Chinwe Uzoma
- Molecular-Hematology and Immuno Genetics Unit, Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Eltayeb Mohamed Ahmed Tayrab
- Chemical Pathology, Department of Pathology, Faculty of Medicine and Dentistry, Kampala International University, Kampala, Uganda
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de Lima LV, Pavinati G, de Oliveira RR, Couto RDM, Alves KBA, Magnabosco GT. Temporal trend in the incidence of tuberculosis-HIV coinfection in Brazil, by macro-region, Federative Unit, sex and age group, 2010-2021. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2024; 33:e2023522. [PMID: 38381874 PMCID: PMC10880441 DOI: 10.1590/s2237-96222024v33e2023522.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/22/2023] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To analyze the temporal trend in the incidence of tuberculosis-HIV coinfection in Brazil, by macro-region, Federative Unit, sex and age group, from 2010 to 2021. METHODS This was a time series study using surveillance data to estimate average annual percentage changes (AAPC), and 95% confidence intervals (95%CI) via joinpoint regression. RESULTS 122,211 cases of tuberculosis-HIV coinfection were analyzed; a falling trend was identified for Brazil as a whole (AAPC = -4.3; 95%CI -5.1;-3.7), and in the country's Southern (AAPC = -6.2; 95%CI -6.9;-5.5) and Southeast (AAPC = -4.6; 95%CI -5.6;-3.8) regions, even more so during the COVID-19 pandemic (2020-2021); the greatest falling trend was seen in Santa Catarina (AAPC = -9.3; 95%CI -10.1;-8.5), while the greatest rising trend was found in Tocantins (AAPC = 4.1; 95%CI 0.1;8.6); there was a rising trend among males, especially in Sergipe (AAPC = 3.9; 95%CI 0.4;7.9), and those aged 18 to 34 years, especially in Amapá (AAPC = 7.9; 95%CI 5.1;11.5). CONCLUSION The burden and trends of tuberculosis-HIV coinfection were geographically and demographically disparate.
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Affiliation(s)
- Lucas Vinícius de Lima
- Universidade Estadual de Maringá, Programa de Pós-Graduação em
Enfermagem, Maringá, PR, Brazil
| | - Gabriel Pavinati
- Universidade Estadual de Maringá, Programa de Pós-Graduação em
Enfermagem, Maringá, PR, Brazil
| | | | | | - Kleydson Bonfim Andrade Alves
- Organização Pan-Americana da Saúde, Departamento de Doenças
Transmissíveis e Determinantes Ambientais da Saúde, Brasília, DF, Brazil
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Dlatu N, Longo-Mbenza B, Apalata T. Models of integration of TB and HIV services and factors associated with perceived quality of TB-HIV integrated service delivery in O. R Tambo District, South Africa. BMC Health Serv Res 2023; 23:804. [PMID: 37501061 PMCID: PMC10375732 DOI: 10.1186/s12913-023-09748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 06/24/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Tuberculosis is the leading infectious cause of death among people living with HIV. Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with fully integrated, people-centered models of care. METHODS This is a qualitative study design using principles of ethnography and the application of aggregate complexity theory. A total of 54 individual interviews with healthcare workers and patients took place in five primary healthcare facilities in the O.R. Tambo district. The participants were purposively selected until the data reached saturation point, and all interviews were tape-recorded. Quantitative analysis of qualitative data was used after coding ethnographic data, looking for emerging patterns, and counting the number of times a qualitative code occurred. A Likert scale was used to assess the perceived quality of TB/HIV integration. Regression models and canonical discriminant analyses were used to explore the associations between the perceived quality of TB and HIV integrated service delivery and independent predictors of interest using SPSS® version 23.0 (Chicago, IL) considering a type I error of 0.05. RESULTS Of the 54 participants, 39 (72.2%) reported that TB and HIV services were partially integrated while 15 (27.8%) participants reported that TB/HIV services were fully integrated. Using the Likert scale gradient, 23 (42.6%) participants perceived the quality of integrated TB/HIV services as poor while 13 (24.1%) and 18 (33.3%) perceived the quality of TB/HIV integrated services as moderate and excellent, respectively. Multiple linear regression analysis showed that access to healthcare services was significantly and independently associated with the perceived quality of integrated TB/HIV services following the equation: Y = 3.72-0.06X (adjusted R2 = 23%, p-value = 0.001). Canonical discriminant analysis (CDA) showed that in all 5 municipal facilities, long distances to healthcare facilities leading to reduced access to services were significantly more likely to be the most impeding factor, which is negatively influencing the perceived quality of integrated TB/HIV services, with functions' coefficients ranging from 9.175 in Mhlontlo to 16.514 in KSD (Wilk's Lambda = 0.750, p = 0.043). CONCLUSION HIV and TB integration is inadequate with limited access to healthcare services. Full integration (one-stop-shop services) is recommended.
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Affiliation(s)
- Ntandazo Dlatu
- Division of Public Health, Department of Community Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Benjamin Longo-Mbenza
- Division of Public Health, Department of Community Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Teke Apalata
- Division of Medical Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University and National Health Laboratory Services, Mthatha, South Africa.
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Dlatu N, Longo-Mbenza B, Oladimeji KE, Apalata T. Developing a Model for Integrating of Tuberculosis, Human Immunodeficiency Virus and Primary Healthcare Services in Oliver Reginald (O.R) Tambo District, Eastern Cape, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5977. [PMID: 37297581 PMCID: PMC10252508 DOI: 10.3390/ijerph20115977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/14/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
Despite the policy, frameworks for integration exist; integration of TB and HIV services is far from ideal in many resource-limited countries, including South Africa. Few studies have examined the advantages and disadvantages of integrated TB and HIV care in public health facilities, and even fewer have proposed conceptual models for proven integration. This study aims to fill this vacuum by describing the development of a paradigm for integrating TB, HIV, and patient services in a single facility and highlights the importance of TB-HIV services for greater accessibility under one roof. Development of the proposed model occurred in several phases that included assessment of the existing integration model for TB-HIV and synthesis of quantitative and qualitative data from the study sites, which were selected public health facilities in rural and peri-urban areas in the Oliver Reginald (O.R.) Tambo District Municipality in the Eastern Cape, South Africa. Secondary data on clinical outcomes from 2009-2013 TB-HIV were obtained from various sources for the quantitative analysis of Part 1. Qualitative data included focus group discussions with patients and healthcare workers, which were analyzed thematically in Parts 2 and 3. The development of a potentially better model and the validation of this model shows that the district health system was strengthened by the guiding principles of the model, which placed a strong emphasis on inputs, processes, outcomes, and integration effects. The model is adaptable to different healthcare delivery systems but requires the support of patients, providers (professionals and institutions), payers, and policymakers to be successful.
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Affiliation(s)
- Ntandazo Dlatu
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha 5117, South Africa;
| | - Benjamin Longo-Mbenza
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha 5117, South Africa;
| | | | - Teke Apalata
- Department of Laboratory Medicine and Pathology, Faculty of Health Sciences and National Health Laboratory Services (NHLS), Walter Sisulu University, Private Bag X1, Mthatha 5117, South Africa;
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Amkongo M, Mitonga HK, Alfeus A, Shipingana LNN, Keendjele T, Eelu H, Nashihanga T. Factors associated with the unsuccessful TB treatment outcomes in the northern regions of Namibia: a mixed methods study. BMC Infect Dis 2023; 23:342. [PMID: 37217848 DOI: 10.1186/s12879-023-08268-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is among the leading causes of death globally. The disease has a huge burden in Namibia, with a case notification rate of at least 442 per 100,000. To date, Namibia is among the countries with the highest global TB burden, despite all efforts to reduce it. This study aimed to determine the factors associated with the unsuccessful treatment outcomes of the Directly Observed Therapy Short course (DOTS) programme in the Kunene and Oshana regions. METHODS The study utilised a mixed-methods explanatory-sequential design to collect data from all TB patient records and healthcare workers who work directly with the DOTS strategy for TB patients. The relationship between independent and dependent variables was analysed using multiple logistic regression analysis, while interviews were analysed using inductive thematic analysis. RESULTS The overall treatment success rates of the Kunene and Oshana regions throughout the review period were 50.6% and 49.4%, respectively. The logistic regression analyses showed that in the Kunene region, the type of DOT used (Community-based DOTS) (aOR = 0.356, 95% CI: 0.835-2.768, p = 0.006) was statistically significant with the unsuccessful treatment outcomes. While in the Oshana region, age groups 21-30 years old (aOR = 1.643, 95% CI = 1.005-2.686, p = 0.048), 31-40 years old (aOR = 1.725, 95% CI = 11.026-2.9, p = 0.040), 41-50 years old (aOR = 2.003, 95% CI = 1.155-3.476, p = 0.013) and 51-60 years old (aOR = 2.106, 95% CI = 1.228-3.612, p = 0.007) had statistically significant associations with the poor TB-TO. Inductive thematic analysis revealed that patients in the Kunene region were challenging to reach owing to their nomadic lifestyle and the vastness of the area, adversely affecting their ability to observe TB therapy directly. In the Oshana region, it was found that stigma and poor TB awareness among adult patients, as well as mixing anti-TB medication with alcohol and tobacco products among adult patients, was a prevalent issue affecting TB therapy. CONCLUSION The study recommends that regional health directorates embark on rigorous community health education about TB treatment and risk factors and establish a robust patient observation and monitoring system to enhance inclusive access to all health services and ensure treatment adherence.
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Affiliation(s)
- Mondjila Amkongo
- Department of Radiography, School of Allied Health Sciences, University of Namibia, P.O Box 3728, Windhoek, Namibia.
| | - Honoré K Mitonga
- Public Health Department, School of Nursing and Public Health, University of Namibia, Windhoek, Namibia
| | - Anna Alfeus
- Public Health Department, School of Nursing and Public Health, University of Namibia, Windhoek, Namibia
| | | | - Tuwilika Keendjele
- Department of Human, Biological & Translational Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Hilja Eelu
- Department of Human, Biological & Translational Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Tunelago Nashihanga
- Department of Human, Biological & Translational Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia
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Tornu E, Quarcoopome L. Correlates of quality of life among persons living with tuberculosis: A cross-sectional study. PLoS One 2022; 17:e0277192. [PMID: 36331938 PMCID: PMC9635747 DOI: 10.1371/journal.pone.0277192] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The correlates of quality of life originating from the demographic characteristics, comorbidities and sources of social support among persons living with tuberculosis remain underreported. The aim of this study was to examine the correlates of quality of life among persons living with tuberculosis within Greater Accra, Ghana. Methods A cross-sectional survey design was used to assess the correlates of quality of life among 250 randomly sampled persons living with tuberculosis. Quality of life was assessed with the Quality of Life Brief Version (WHOQOL-BREF) questionnaire and correlates were derived using Spearman rho correlations. Chi-square analyses assessed associations among respondent characteristics. Results All four quality of life domains (physical, psychological, social relationship and environmental) of persons living with tuberculosis were positively correlated. Furthermore, receiving social support from family or friends correlated positively with respondents’ quality of life. Human Immunodeficiency Virus (HIV) infection and receiving social support mainly from work colleagues or religious institutions correlated negatively with respondents’ quality of life domains. Other correlates of quality of life included age, pleuritis with pleural effusion, number of dependants and distance to tuberculosis treatment centres. Social support from family and friends corresponded with better quality of life among persons living with tuberculosis. Conclusion The quality of life domains of persons living with tuberculosis are interrelated and can be enhanced by social support. Healthcare providers should involve the significant others of persons living with tuberculosis, human immunodeficiency virus and pleuritis with pleural effusion in their care to promote patients’ quality of life.
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Affiliation(s)
- Eric Tornu
- Department of Adult Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Louisa Quarcoopome
- Department of Internal Medicine and Therapeutics, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
- * E-mail:
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Sullivan A, Nathavitharana RR. Addressing TB-related mortality in adults living with HIV: a review of the challenges and potential solutions. Ther Adv Infect Dis 2022; 9:20499361221084163. [PMID: 35321342 PMCID: PMC8935406 DOI: 10.1177/20499361221084163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/12/2022] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis (TB) is the leading cause of death in people living with HIV (PLHIV) globally, causing 208,000 deaths in PLHIV in 2019. PLHIV have an 18-fold higher risk of TB, and HIV/TB mortality is highest in inpatient facilities, compared with primary care and community settings. Here we discuss challenges and potential mitigating solutions to address TB-related mortality in adults with HIV. Key factors that affect healthcare engagement are stigma, knowledge, and socioeconomic constraints, which are compounded in people with HIV/TB co-infection. Innovative approaches to improve healthcare engagement include optimizing HIV/TB care integration and interventions to reduce stigma. While early diagnosis of both HIV and TB can reduce mortality, barriers to early diagnosis of TB in PLHIV include difficulty producing sputum specimens, lower sensitivity of TB diagnostic tests in PLHIV, and higher rates of extra pulmonary TB. There is an urgent need to develop higher sensitivity biomarker-based tests that can be used for point-of-care diagnosis. Nonetheless, the implementation and scale-up of existing tests including molecular World Health Organization (WHO)-recommended diagnostic tests and urine lipoarabinomannan (LAM) should be optimized along with expanded TB screening with tools such as C-reactive protein and digital chest radiography. Decreased survival of PLHIV with TB disease is more likely with late HIV diagnosis and delayed start of antiretroviral (ART) treatment. The WHO now recommends starting ART within 2 weeks of initiating TB treatment in the majority of PLHIV, aside from those with TB meningitis. Dedicated TB treatment trials focused on PLHIV are needed, including interventions to improve TB meningitis outcomes given its high mortality, such as the use of intensified regimens using high-dose rifampin, new and repurposed drugs such as linezolid, and immunomodulatory therapy. Ultimately holistic, high-quality, person-centered care is needed for PLHIV with TB throughout the cascade of care, which should address biomedical, socioeconomic, and psychological barriers.
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Affiliation(s)
- Amanda Sullivan
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Ruvandhi R. Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
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