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
Vanderbilt Univ. School of Medicine, Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee, United States of America.
National Hospital of Tropical Diseases, Hanoi, Vietnam.
PLoS One. 2016 Apr 13;11(4):e0153243. doi: 10.1371/journal.pone.0153243. eCollection 2016.
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.
To assess the implementation of the "Three I's" of TB-control at HIV treatment sites in lower income countries.
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.
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).
Implementation of TB screening, IPT provision, and infection control measures was low and variable across regional HIV treatment sites, regardless of integration status.
世界卫生组织倡导整合艾滋病毒-结核病（TB）服务，并建议对艾滋病毒感染者进行结核病预防和控制采用强化病例发现（ICF）、异烟肼预防性治疗（IPT）和感染控制（“三个I”）。
评估低收入国家艾滋病毒治疗场所结核病控制“三个I”的实施情况。
2012年3月至7月在26个国家的47个场所进行调查：6个（13%）亚太地区、7个（15%）加勒比地区、中美洲和南美洲、5个（10%）中非、8个（17%）东非、14个（30%）南部非洲和7个（15%）西非。
38%的场所采用基于症状的筛查进行ICF；45%的场所使用症状筛查加额外诊断。仅17%的场所对入组或开始抗逆转录病毒治疗时进行IPT，9%的场所为结核菌素皮肤试验阳性患者提供IPT。感染控制措施各不相同：62%的场所隔离涂片阳性患者，57%的场所医护人员使用口罩。只有12个（26%）场所整合了艾滋病毒-结核病服务。除了入组时提供IPT外，整合与结核病预防措施的实施无关（42%整合场所与9%未整合场所；p = 0.03）。
无论整合状况如何，区域艾滋病毒治疗场所的结核病筛查、IPT提供和感染控制措施的实施率都很低且各不相同。
