Zürcher Kathrin, Cox Samyra R, Ballif Marie, Enane Leslie A, Marcy Olivier, Yotebieng Marcel, Reubenson Gary, Imsanguan Worarat, Otero Larissa, Suryavanshi Nishi, Duda Stephany N, Egger Matthias, Tornheim Jeffrey A, Fenner Lukas
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
PLOS Glob Public Health. 2022;2(3). doi: 10.1371/journal.pgph.0000180. Epub 2022 Mar 1.
Tuberculosis (TB) is the leading cause of death among PLHIV and multidrug-resistant-TB (MDR-TB) is associated with high mortality. We examined the management for adult PLHIV coinfected with MDR-TB at ART clinics in lower income countries. Between 2019 and 2020, we conducted a cross-sectional survey at 29 ART clinics in high TB burden countries within the global IeDEA network. We used structured questionnaires to collect clinic-level data on the TB and HIV services and the availability of diagnostic tools and treatment for MDR-TB. Of 29 ART clinics, 25 (86%) were in urban areas and 19 (66%) were tertiary care clinics. Integrated HIV-TB services were reported at 25 (86%) ART clinics for pan-susceptible TB, and 14 (48%) clinics reported full MDR-TB services on-site, i.e. drug susceptibility testing [DST] and MDR-TB treatment. Some form of DST was available on-site at 22 (76%) clinics, while the remainder referred testing off-site. On-site DST for second-line drugs was available at 9 (31%) clinics. MDR-TB treatment was delivered on-site at 15 (52%) clinics, with 10 individualizing treatment based on DST results and five using standardized regimens alone. Bedaquiline was routinely available at 5 (17%) clinics and delamanid at 3 (10%) clinics. Although most ART clinics reported having integrated HIV and TB services, few had fully integrated MDR-TB services. There is a continued need for increased access to diagnostic and treatment options for MDR-TB patients and better integration of MDR-TB services into the HIV care continuum.
结核病（TB）是艾滋病毒感染者中主要的死亡原因，而耐多药结核病（MDR-TB）与高死亡率相关。我们研究了低收入国家抗逆转录病毒治疗（ART）诊所中成年艾滋病毒感染者合并耐多药结核病的管理情况。在2019年至2020年期间，我们在全球IeDEA网络中结核病负担较高国家的29家ART诊所进行了一项横断面调查。我们使用结构化问卷收集关于结核病和艾滋病毒服务以及耐多药结核病诊断工具和治疗可用性的诊所层面数据。在29家ART诊所中，25家（86%）位于城市地区，19家（66%）是三级护理诊所。25家（86%）ART诊所报告提供了针对泛敏感结核病的综合艾滋病毒-结核病服务，14家（48%）诊所报告现场提供全面的耐多药结核病服务，即药敏试验[DST]和耐多药结核病治疗。22家（76%）诊所现场提供某种形式的DST，其余诊所则将检测转诊至外部。9家（31%）诊所现场提供二线药物的DST。15家（52%）诊所现场提供耐多药结核病治疗，其中10家根据DST结果进行个体化治疗，5家仅使用标准化治疗方案。5家（17%）诊所常规提供贝达喹啉，3家（10%）诊所提供德拉马尼。尽管大多数ART诊所报告提供了艾滋病毒和结核病综合服务，但很少有诊所提供完全综合的耐多药结核病服务。仍持续需要增加耐多药结核病患者获得诊断和治疗选择的机会，并更好地将耐多药结核病服务纳入艾滋病毒护理连续体。
