Tuberculosis treatment within differentiated service delivery models in global HIV/TB programming

Area of Science:

• Public Health
• Infectious Diseases
• HIV/AIDS Management

Background:

• Global HIV programs prioritize patient-centered care through differentiated service delivery (DSD) models.
• The COVID-19 pandemic accelerated the adoption of DSD for various HIV services, including antiretroviral therapy and preventive treatments.
• Traditionally, tuberculosis (TB) treatment for people living with HIV (PLHIV) required frequent clinic visits.

Purpose of the Study:

• To outline considerations for adapting DSD models for TB treatment delivery among PLHIV.
• To leverage existing DSD platforms for improved TB management within HIV care.
• To enhance patient satisfaction, retention, and clinical outcomes for TB/HIV co-infected individuals.

Main Methods:

• Review of best practices in global DSD implementation for HIV services.
• Discussion of operational elements for TB treatment within DSD, including screening, diagnosis, dispensing, patient support, clinical management, and monitoring.
• Consideration of electronic tools and virtual monitoring for adherence and adverse event management.

Main Results:

• DSD models can be effectively adapted for TB treatment, incorporating multi-month dispensing and virtual monitoring.
• Operationalization requires careful planning across various program elements, from diagnosis to reporting.
• Early implementation experiences, such as in Zambia, demonstrate feasibility.

Conclusions:

• The expansion of DSD models, catalyzed by COVID-19, presents an opportunity to integrate TB treatment.
• Adapting DSD for TB treatment can capitalize on existing HIV service delivery platforms.
• This integration promises high-quality, routine care, improved patient education, and empowerment for PLHIV with TB.