Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA.
Division of Global HIV and TB, CDC Nigeria, Abuja, Nigeria; and.
J Acquir Immune Defic Syndr. 2020 Dec 1;85(4):450-453. doi: 10.1097/QAI.0000000000002483.
Tuberculosis preventive treatment (TPT) is a critical intervention to reduce tuberculosis mortality among people living with HIV (PLHIV). To facilitate scale-up of TPT among PLHIV, the Nigeria Ministry of Health and the US Centers for Disease Control and Prevention (CDC) Nigeria, supported by US President's Emergency Plan for AIDS Relief implementing partners, launched a TPT-focused technical assistance strategy in high-volume antiretroviral treatment (ART) sites during 2018.
Nigeria has an estimated 1.9 million PLHIV, representing the second largest national burden of PLHIV in the world, and an estimated 53% of PLHIV are on ART.
In 50 high-volume ART sites, we assessed readiness for TPT scale-up through use of a standardized tool across the following 5 areas: clinical training, community education, patient management, commodities and logistics management, and recording and reporting. We deployed a site-level continuous quality improvement strategy to facilitate TPT scale-up. Implementing partners rapidly disseminated best practices from these sites to across all CDC-supported sites and reported aggregate data on monthly TPT initiations.
Through this targeted assistance and rapid dissemination of best practices to all other sites, the number of PLHIV who initiated TPT across all CDC-supported sites increased from 6622 in May 2018, when the approach was implemented, to 48,661 in September 2018. Gains in monthly TPT initiations were sustained through March 2019.
Use of a standardized tool for assessing readiness for TPT scale-up provided a "checklist" of potential barriers to TPT scale-up to address at each site. The quality improvement approach allowed each site to design a specific plan to achieve desired TPT scale-up, and best practices were implemented concurrently at other, smaller sites. The approach could assist scale-up of TPT among PLHIV in other countries.
结核病预防治疗（TPT）是降低艾滋病毒感染者（PLHIV）结核病死亡率的关键干预措施。为了促进 TPT 在 PLHIV 中的推广，尼日利亚卫生部和美国疾病控制与预防中心（CDC）尼日利亚在美援署艾滋病紧急救援计划实施伙伴的支持下，于 2018 年在大量抗逆转录病毒治疗（ART）点启动了一项以 TPT 为重点的技术援助战略。
尼日利亚估计有 190 万 PLHIV，是世界上 PLHIV 第二大国家负担国，估计有 53%的 PLHIV 在接受 ART。
在 50 个大容量的 ART 点，我们使用标准化工具评估了 TPT 推广的准备情况，评估内容涵盖以下 5 个方面：临床培训、社区教育、患者管理、商品和物流管理以及记录和报告。我们部署了一个基于地点的持续质量改进策略，以促进 TPT 的推广。实施伙伴迅速将这些地点的最佳实践传播到所有 CDC 支持的地点，并报告每月 TPT 启动的综合数据。
通过这种有针对性的援助和向所有其他地点快速传播最佳实践，CDC 支持的所有地点中开始 TPT 的 PLHIV 人数从 2018 年 5 月（实施该方法时）的 6622 人增加到 2018 年 9 月的 48661 人。到 2019 年 3 月，每月 TPT 启动的增长仍在持续。
使用标准化工具评估 TPT 推广的准备情况为每个地点提供了一个 TPT 推广的潜在障碍“清单”。质量改进方法允许每个地点设计具体的计划来实现所需的 TPT 推广，并且最佳实践同时在其他较小的地点实施。该方法可协助其他国家推广 PLHIV 的 TPT。
