Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence RI, USA.
Institute for Global Health, University College London, London, UK.
Int J Tuberc Lung Dis. 2022 Aug 1;26(8):727-732. doi: 10.5588/ijtld.21.0477.
The WHO recommends TB preventive treatment (TPT) for people living with HIV, including pregnant women. Uptake of this policy recommendation in this subpopulation and country alignment with WHO guidance is unclear. We conducted a policy review in 38 WHO high TB and TB-HIV burden countries to assess if the uptake of TPT policy among pregnant women living with HIV was in line with the WHO´s 2018 Updated and Consolidated Guidelines for Programmatic Management for LTBI. Data sources included TB national guidelines and HIV/AIDS/ART national guidelines, complemented by results from a previous survey on policy uptake held at the WHO. Uptake of WHO policy to provide TB preventive treatment among women with HIV accessing antenatal care was moderate: 64% (23 of 36 countries) explicitly recommended at least one clinical guideline or policy recommendation on screening, testing or treatment of LTBI among pregnant women living with HIV. There was considerable variation between countries on the stages in pregnancy that TPT should be provided. Two countries (5%) provided clinical monitoring recommendations for pregnant women. There is moderate uptake of TPT policy for pregnant women with HIV. Failure to provide TPT as part of antenatal or prevention of mother-to-child services is a missed opportunity for TB control.
世界卫生组织建议对包括孕妇在内的艾滋病毒感染者开展结核预防性治疗（TPT）。但不清楚在该人群中，各国对这一政策建议的采纳情况以及是否与世卫组织的指导意见保持一致。我们对 38 个世卫组织高结核和结核-艾滋病毒负担国家进行了政策审查，以评估在艾滋病毒感染者孕妇中采取 TPT 政策的情况是否符合世卫组织 2018 年更新和综合潜伏性结核感染管理规划实施指南。数据来源包括结核国家指南和艾滋病毒/艾滋病/抗逆转录病毒国家指南，并辅以世卫组织之前进行的一项关于政策采纳情况的调查结果。在接受产前护理的艾滋病毒感染者妇女中提供结核预防性治疗的世卫组织政策采纳情况处于中等水平：64%（36 个国家中的 23 个）明确建议至少有一份关于艾滋病毒感染者孕妇筛查、检测或治疗潜伏性结核感染的临床指南或政策建议。各国在应何时为孕妇提供 TPT 方面存在相当大的差异。有两个国家（5%）提供了对孕妇进行临床监测的建议。艾滋病毒感染者孕妇的 TPT 政策采纳情况处于中等水平。未能将 TPT 作为产前或母婴传播预防服务的一部分提供，是控制结核的一个错失的机会。
