ICAP Zimbabwe, Harare, Zimbabwe.
ICAP at Columbia University, New York City, New York, USA.
J Int AIDS Soc. 2023 Jun;26(6):e26105. doi: 10.1002/jia2.26105.
Tuberculosis (TB) causes one-third of HIV-related deaths worldwide, making TB preventive treatment (TPT) a critical element of HIV programmes. Approximately 16% of people living with HIV (PLHIV) on antiretrovirals in Zimbabwe are enrolled in the Fast Track (FT) differentiated service delivery model, which includes multi-month dispensing of antiretrovirals and quarterly health facility (HF) visits. We assessed the feasibility and acceptability of utilizing FT to deliver 3HP (3 months of once-weekly rifapentine and isoniazid) for TPT by aligning TPT and HIV visits, providing multi-month dispensing of 3HP, and using phone-based monitoring and adherence support.
We recruited a purposive sample of 50 PLHIV enrolled in FT at a high-volume HF in urban Zimbabwe. At enrolment, participants provided written informed consent, completed a baseline survey, and received counselling, education and a 3-month supply of 3HP. A study nurse mentor called participants at weeks 2, 4 and 8 to monitor and support adherence and side effects. When participants returned for their routine 3-month FT visit, they completed another survey, and study staff conducted a structured medical record review. In-depth interviews were conducted with providers who participated in the pilot.
Participants were enrolled between April and June 2021 and followed through September 2021. Median age = 32 years (IQR 24,41), 50% female, median time in FT 1.8 years (IQR 0.8,2.7). Forty-eight participants (96%) completed 3HP in 13 weeks; one completed in 16 weeks, and one stopped due to jaundice. Most participants (94%) reported "always" or "almost always" taking 3HP correctly. All reported they were very satisfied with the counselling, education, support and quality of care they received from providers and FT service efficiency. Almost all (98%) said they would recommend it to other PLHIV. Challenges reported included pill burden (12%) and tolerability (24%), but none had difficulty with phone-based counselling or wished for additional HF-based visits.
Using FT to deliver 3HP was feasible and acceptable. Some reported tolerability challenges but 98% completed 3HP, and all appreciated the efficiency of aligning TPT and HIV HF visits, multi-month dispensing and phone-based counselling.
Scaling up this approach could expand TPT coverage in Zimbabwe.
结核病（TB）导致全球三分之一的艾滋病相关死亡，使结核病预防性治疗（TPT）成为艾滋病规划的关键内容。津巴布韦约有 16%接受抗逆转录病毒治疗的艾滋病毒感染者（PLHIV）参加了快速通道（FT）差异化服务提供模式，其中包括抗逆转录病毒药物的多剂量配给和每季度一次的医疗机构（HF）就诊。我们评估了利用 FT 来提供 3HP（3 个月每周一次利福喷丁和异烟肼）进行 TPT 的可行性和可接受性，方法是将 TPT 和 HIV 就诊相匹配，提供 3HP 的多剂量配给，并使用基于电话的监测和依从性支持。
我们在津巴布韦城市的一个高容量 HF 招募了 50 名参加 FT 的 PLHIV 作为研究对象。在入组时，参与者提供了书面知情同意书，完成了基线调查，并接受了咨询、教育和 3 个月的 3HP 供应。一名研究护士导师在第 2、4 和 8 周时打电话给参与者，以监测和支持他们的依从性和副作用。当参与者返回进行常规的 3 个月 FT 就诊时，他们完成了另一项调查，研究人员对病历进行了结构化审查。对参与试点的提供者进行了深入访谈。
参与者于 2021 年 4 月至 6 月间入组，随访至 2021 年 9 月。中位年龄=32 岁（IQR 24,41），50%为女性，中位 FT 时间为 1.8 年（IQR 0.8,2.7）。48 名参与者（96%）在 13 周内完成了 3HP 治疗；1 名参与者在 16 周时完成，1 名因黄疸而停止治疗。大多数参与者（94%）报告说他们“总是”或“几乎总是”正确服用 3HP。所有人都表示对提供者提供的咨询、教育、支持和护理质量以及 FT 服务效率非常满意。几乎所有人（98%）都表示会向其他 PLHIV 推荐它。报告的挑战包括药物负担（12%）和耐受性（24%），但没有人对基于电话的咨询有困难，也没有人希望增加 HF 就诊次数。
利用 FT 提供 3HP 是可行和可接受的。有些人报告了耐受性方面的挑战，但 98%的人完成了 3HP 治疗，所有人都赞赏 TPT 和 HIV HF 就诊相匹配、多剂量配给和基于电话的咨询的效率。
扩大这种方法可以扩大津巴布韦的 TPT 覆盖面。
