Hartsough Kieran, Teasdale Chloe A, Shongwe Siphesihle, Geller Amanda, Pimentel De Gusmao Eduarda, Dlamini Phumzile, Mafukidze Arnold, Pasipamire Munyaradzi, Ao Trong, Ryan Caroline, Modi Surbhi, Abrams Elaine J, Howard Andrea A
ICAP-Columbia University, Mailman School of Public Health, New York, NY, United States of America.
CUNY Graduate School of Public Health & Health Policy, Department of Epidemiology & Biostatistics, New York, NY, United States of America.
PLOS Glob Public Health. 2022 Apr 20;2(4):e0000217. doi: 10.1371/journal.pgph.0000217. eCollection 2022.
Tuberculosis (TB) primarily affects women during their reproductive years and contributes to maternal mortality and poor pregnancy outcomes. For pregnant women living with HIV (WLHIV), TB is the leading cause of non-obstetric maternal mortality, and pregnant WLHIV with TB are at increased risk of transmitting both TB and HIV to their infants. TB diagnosis among pregnant women, particularly WLHIV, remains challenging, and TB preventive treatment (TPT) coverage among pregnant WLHIV is limited. This project aimed to strengthen integrated TB and reproductive, maternal, neonatal and child health (RMNCH) services in Eswatini to improve screening and treatment for TB disease, TPT uptake and completion among women receiving RMNCH services. The project was conducted from April-December 2017 at four health facilities in Eswatini and introduced enhanced monitoring tools and on-site technical support in RMNCH services. We present data on TB case finding among women, and TPT coverage and completion among eligible WLHIV. A questionnaire (S1 Appendix) measured healthcare provider perspectives on the project after three months of project implementation, including feasibility of scaling-up integrated TB and RMNCH services. A total of 5,724 women (HIV-negative or WLHIV) were screened for active TB disease while attending RMNCH services; 53 (0.9%) were identified with presumptive TB, of whom 37 (70%) were evaluated for TB disease and 6 (0.1% of those screened) were diagnosed with TB. Among 1,950 WLHIV who screened negative for TB, 848 (43%) initiated TPT and 462 (54%) completed. Forty-three healthcare providers completed the questionnaire, and overall were highly supportive of integrated TB and RMNCH services. Integration of TB/HIV services in RMNCH settings was feasible and ensured high TB screening coverage among women of reproductive age, however, symptom screening identified few TB cases, and further studies should explore various screening algorithms and diagnostics that optimize case finding in this population. Interventions should focus on working with healthcare providers and patients to improve TPT initiation and completion rates.
结核病（TB）主要影响处于生育年龄的女性，并导致孕产妇死亡和不良妊娠结局。对于感染艾滋病毒的孕妇（WLHIV）而言，结核病是非产科孕产妇死亡的主要原因，感染结核病的WLHIV孕妇将结核病和艾滋病毒传播给婴儿的风险更高。孕妇，尤其是WLHIV的结核病诊断仍然具有挑战性，并且感染结核病的WLHIV孕妇中结核病预防性治疗（TPT）的覆盖率有限。该项目旨在加强斯威士兰的结核病与生殖、孕产妇、新生儿和儿童健康（RMNCH）综合服务，以改善接受RMNCH服务的妇女对结核病的筛查和治疗、TPT的接受率和完成率。该项目于2017年4月至12月在斯威士兰的四个医疗机构开展，并在RMNCH服务中引入了强化监测工具和现场技术支持。我们展示了女性结核病病例发现情况以及符合条件的WLHIV中TPT的覆盖率和完成率的数据。在项目实施三个月后，通过一份调查问卷（附录S1）收集了医疗服务提供者对该项目的看法，包括扩大结核病与RMNCH综合服务的可行性。共有5724名女性（艾滋病毒阴性或WLHIV）在接受RMNCH服务时接受了活动性结核病筛查；53人（0.9%）被诊断为疑似结核病，其中37人（70%）接受了结核病评估，6人（占筛查人数的0.1%）被诊断为结核病。在1950名结核病筛查呈阴性的WLHIV中，848人（43%）开始接受TPT，462人（54%）完成了治疗。43名医疗服务提供者完成了调查问卷，总体上高度支持结核病与RMNCH综合服务。在RMNCH环境中整合结核病/艾滋病毒服务是可行的，并确保了育龄妇女的高结核病筛查覆盖率，然而，症状筛查发现的结核病病例很少，进一步的研究应探索各种筛查算法和诊断方法，以优化该人群中的病例发现。干预措施应侧重于与医疗服务提供者和患者合作，以提高TPT的启动率和完成率。
