Boyd A T, Moore B, Shah M, Tran C, Kirking H, Cavanaugh J S, Al-Samarrai T, Pathmanathan I
Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Office of the Global AIDS Coordinator, Washington DC, USA.
Public Health Action. 2020 Sep 21;10(3):104-110. doi: 10.5588/pha.20.0014.
Global HIV program stakeholders, including the US President's Emergency Plan for AIDS Relief (PEPFAR), are undertaking efforts to ensure that eligible people living with HIV (PLHIV) receiving antiretroviral treatment (ART) receive a course of TB preventive treatment (TPT). In PEPFAR programming, this effort may require providing TPT not only to newly diagnosed PLHIV as part of HIV care initiation, but also to treatment-experienced PLHIV stable on ART who may not have been previously offered TPT. TPT scale-up is occurring at the same time as a trend to provide more person-centered HIV care through differentiated service delivery (DSD). In DSD, PLHIV stable on ART may receive less frequent clinical follow-up or receive care outside the traditional clinic-based model. The misalignment between traditional delivery of TPT and care delivery in innovative DSD may require adaptations to TPT delivery practices for PLHIV. Adaptations include components of planning and operationalization of TPT in DSD, such as determination of TPT eligibility and TPT initiation, and clinical management of PLHIV while on TPT. A key adaptation is alignment of timing and location for TPT and ART prescribing, monitoring, and dispensing. Conceptual examples of TPT delivery in DSD may help program managers operationalize TPT in HIV care.
包括美国总统艾滋病紧急救援计划（PEPFAR）在内的全球艾滋病项目利益相关者，正在努力确保符合条件的艾滋病病毒感染者（PLHIV）在接受抗逆转录病毒治疗（ART）时能够接受一个疗程的结核病预防性治疗（TPT）。在PEPFAR项目中，这项工作可能不仅需要在启动艾滋病护理时为新诊断的PLHIV提供TPT，还需要为接受ART治疗且病情稳定但之前可能未接受过TPT的有治疗经验的PLHIV提供TPT。在扩大TPT规模的同时，还出现了一种通过差异化服务提供（DSD）提供更以人为本的艾滋病护理的趋势。在DSD模式下，接受ART治疗且病情稳定的PLHIV可能接受临床随访的频率较低，或者在传统的基于诊所的模式之外接受护理。传统的TPT提供方式与创新的DSD模式下的护理提供方式之间的不一致，可能需要调整针对PLHIV的TPT提供方式。调整内容包括DSD中TPT规划和实施的组成部分，如确定TPT资格和开始TPT治疗，以及PLHIV在接受TPT治疗期间的临床管理。一个关键的调整是使TPT与ART的处方开具、监测和配药在时间和地点上保持一致。DSD模式下TPT提供的概念示例可能有助于项目管理人员在艾滋病护理中实施TPT。
