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Tuberculosis Diagnosis, Treatment, and Prevention Services for Children Living with HIV in Low- and Middle-Income
Katherine Laycock1, Karl-Günter Technau2, Patricia Lelo3
1The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, IN, United States.
Insights
Tuberculosis (TB) screening and treatment for children living with HIV (CLHIV) in low- and middle-income countries show promise, but significant gaps in diagnostics and TB preventive therapy (TPT) delivery persist. Continued attention is needed to improve TB care outcomes for CLHIV.
Area of Science:
- Global Health
- Infectious Diseases
- Pediatric HIV Care
Background:
- Tuberculosis (TB) is a major cause of illness and death in children living with HIV (CLHIV).
- Significant challenges exist in TB screening, diagnostics, treatment, and TB preventive therapy (TPT) for CLHIV.
- Practices at sites caring for CLHIV in low- and middle-income countries (LMICs) within the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium were investigated.
Purpose of the Study:
- To investigate reported practices in TB screening, diagnostics, management, and TPT at sites caring for CLHIV in LMICs.
- To identify gaps and variations in TB care delivery for CLHIV.
Main Methods:
- A site survey was conducted from September 2020 to February 2021, focusing on pre-pandemic practices.
- The analysis included LMIC sites providing care for CLHIV that diagnosed TB in 2019.
- Descriptive statistics and regional difference assessments using Fisher's exact or chi-square tests were employed.
Main Results:
- Of 135 eligible sites, 90% reported TB screening at HIV care enrollment.
- Access to diagnostics like nucleic acid amplification testing (NAAT), culture, and drug susceptibility testing varied significantly by region (P < .001).
- TB treatment on-site was high (90%), but stock-outs for isoniazid (20%) and other TB medications occurred. TPT provision varied (50%-100%), with 6-month isoniazid being common, but shorter or MDR-TB regimens were infrequent.
Conclusions:
- Reported availability of NAAT and integrated TB/HIV treatment for CLHIV in IeDEA sites is encouraging but context-dependent.
- Implementation gaps persist in drug susceptibility testing, TPT delivery, and TPT regimens.
- These gaps may hinder TB prevention, management, and successful outcomes for CLHIV, necessitating ongoing monitoring and adaptation to evolving global guidelines.
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.
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