Implementation of tuberculosis intensive case finding, isoniazid preventive therapy, and infection control ("Three I's") and HIV-tuberculosis service integration in lower income countries

Charles, M. Katherine ; Lindegren, Mary Lou ; Wester, C. William ; Blevins, Meridith ; Sterling, Timothy R. ; Dung, Nguyen Thi ; Dusingize, Jean Claude ; Avit-Edi, Divine ; Durier, Nicolas ; Castelnuovo, Barbara ; Nakigozi, Gertrude ; Cortes, Claudia P. ; Ballif, Marie ; Fenner, Lukas ; International epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration (2016)

CITATION: Charles, M. K., et al. 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. PLoS ONE, 11(4):e0153243, doi:10.1371/journal.pone.0153243.

The original publication is available at http://journals.plos.org/plosone

Article

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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