Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop US1-1, Atlanta, GA, 30030, USA.
Tropical Diseases Research Centre, Ndola, Zambia.
BMC Public Health. 2021 May 4;21(1):859. doi: 10.1186/s12889-021-10929-z.
The Ministry of Health Zambia recommends tuberculosis preventive treatment (TPT) with 6 months daily isoniazid for all people living with human immunodeficiency virus (HIV) after ruling out active tuberculosis disease. We sought to estimate the percentage of people living with HIV who progress through each stage of the tuberculosis case-finding and prevention cascade in two provinces with the highest tuberculosis burden in Zambia.
In this cross-sectional survey, we used a two-stage cluster sampling method. We sampled 12 healthcare facilities with probability proportional to size. Patient volume determined facility cluster size. During October 2018, from each facility we systematically sampled medical records of adults and children living with HIV. Our primary outcome of interest was TPT initiation rate among eligible people living with HIV, weighted for complex survey design. The Rao-Scott adjusted chi-square test was used to test for differences in TPT initiation rate and other indicators from the tuberculosis prevention cascade by age group and province of residence. Additionally, we conducted semi-structured interviews with healthcare workers at each facility to assess TPT knowledge and identify challenges to its implementation.
We sampled 482 records of people living with HIV (including 128 children living with HIV). Excluding two people diagnosed with tuberculosis disease before enrollment in HIV care, 93.4% underwent tuberculosis symptom screening. Of those, 4.7% were diagnosed with tuberculosis disease and 95.3% were TPT-eligible, of whom 24.7% initiated TPT. TPT initiation was lower among eligible children (7.7%) compared with adults (25.2%, p = 0.03) and Copperbelt residents (3.1%) compared with Lusaka residents (35.8%, p < 0.01). TPT completion rate was 38.4% among people living with HIV who initiated the 6-month course. Among interviewed healthcare workers, 58.3% (unweighted) incorrectly relayed the number of symptoms needed for a positive tuberculosis symptom screen, 83.3% (unweighted) reported insufficient isoniazid stockpile for completion at the time of TPT initiation, and only 27.3% (unweighted) reported receiving TPT-specific training.
TPT uptake among people living with HIV in Zambia is challenged by inconsistent tuberculosis screening, lack of TPT training for healthcare workers, and supply chain inefficiencies. Addressing these barriers may increase TPT initiations and improve outcomes among people living with HIV.
赞比亚卫生部建议对所有艾滋病毒感染者进行为期 6 个月的每日异烟肼预防治疗，以排除活动性结核病。我们试图评估在赞比亚结核病负担最高的两个省份，通过结核病发现和预防级联的每个阶段的艾滋病毒感染者的百分比。
在这项横断面调查中，我们使用了两阶段聚类抽样方法。我们采用与大小成比例的概率抽样了 12 个医疗保健机构。患者数量决定了机构的集群规模。在 2018 年 10 月，我们从每个机构系统地抽取了艾滋病毒感染者的成人和儿童的病历。我们感兴趣的主要结果是符合条件的艾滋病毒感染者中开始预防治疗的比例，按复杂调查设计进行加权。年龄组和居住地省份的结核预防级联的预防治疗开始率和其他指标用 Rao-Scott 调整的卡方检验进行检验。此外，我们还对每个机构的卫生保健工作者进行了半结构化访谈，以评估预防治疗的知识和确定实施的挑战。
我们抽取了 482 份艾滋病毒感染者的记录（包括 128 名艾滋病毒儿童感染者）。在纳入艾滋病毒护理前，排除了两名被诊断患有结核病的人，93.4%的人接受了结核病症状筛查。其中，4.7%被诊断患有结核病，95.3%的人符合预防治疗的条件，其中 24.7%的人开始了预防治疗。符合条件的儿童（7.7%）的预防治疗开始率低于成年人（25.2%，p=0.03）和铜带居民（3.1%）比卢萨卡居民（35.8%，p<0.01）。开始 6 个月疗程的艾滋病毒感染者中，预防治疗完成率为 38.4%。在接受访谈的卫生保健工作者中，58.3%（未加权）错误地传达了结核病症状筛查阳性所需的症状数，83.3%（未加权）报告在开始预防治疗时异烟肼库存不足，只有 27.3%（未加权）报告接受了预防治疗的专门培训。
赞比亚艾滋病毒感染者的预防治疗利用率受到不一致的结核病筛查、卫生保健工作者预防治疗培训不足和供应链效率低下的挑战。解决这些障碍可能会增加预防治疗的启动率，并改善艾滋病毒感染者的结果。
