ICAP at Columbia University, New York, New York, United States of America.
Department of Epidemiology, Mailman School of Public Health Columbia University, New York, New York, United States of America.
PLoS One. 2024 Apr 16;19(4):e0296993. doi: 10.1371/journal.pone.0296993. eCollection 2024.
Tuberculosis (TB) preventive treatment (TPT) is recommended by the World Health Organization (WHO) for persons living with HIV, including pregnant and breastfeeding women. Given the President's Emergency Plan for AIDS Relief (PEPFAR)'s investment in TPT services for persons living with HIV as a strategy to prevent TB as well as uncertainty in guidelines and policy regarding use of TPT during pregnancy and the postpartum period, we conducted a review of current relevant national guidelines among PEPFAR-supported countries.
Our review included 44/49 PEPFAR-supported countries to determine if TB screening and TPT are recommended specifically for pregnant and breastfeeding women living with HIV (WLHIV). National guidelines reviewed and abstracted included TB, HIV, prevention of vertical HIV transmission, TPT, and any other relevant guidelines. We abstracted information regarding TB screening, including screening tools and frequency; and TPT, including timing, regimen, frequency, and laboratory monitoring.
Of 44 PEPFAR-supported countries for which guidelines were reviewed, 66% were high TB incidence countries; 41% were classified by WHO as high TB burden countries, and 43% as high HIV-associated TB burden countries. We found that 64% (n = 28) of countries included TB screening recommendations for pregnant WLHIV in their national guidelines, and most (n = 35, 80%) countries recommend TPT for pregnant WLHIV. Fewer countries included recommendations for breastfeeding as compared to pregnant WLHIV, with only 32% (n = 14) mentioning TB screening and 45% (n = 20) specifically recommending TPT for this population; most of these recommend isoniazid-based TPT regimens for pregnant and breastfeeding WLHIV. However, several countries also recommend isoniazid combined with rifampicin (3RH) or rifapentine (3HP).
Despite progress in the number of PEPFAR-supported countries that specifically include TB screening and TPT recommendations for pregnant and breastfeeding WLHIV in their national guidelines, many PEPFAR-supported countries still do not include specific screening and TPT recommendations for pregnant and breastfeeding WLHIV.
世界卫生组织（WHO）建议对艾滋病毒感染者（包括孕妇和哺乳期妇女）进行结核病（TB）预防治疗（TPT）。鉴于总统艾滋病紧急救援计划（PEPFAR）投资于艾滋病毒感染者的 TPT 服务，将其作为预防结核病的一项战略，同时针对妊娠和产后期间使用 TPT 的指南和政策存在不确定性，我们对 PEPFAR 支持的国家中的当前相关国家指南进行了审查。
我们的审查包括 44/49 个 PEPFAR 支持的国家，以确定是否为艾滋病毒感染者（HIV）的孕妇和哺乳期妇女专门推荐了 TB 筛查和 TPT。审查和提取的国家指南包括 TB、HIV、预防垂直 HIV 传播、TPT 和任何其他相关指南。我们提取了有关 TB 筛查的信息，包括筛查工具和频率；以及 TPT，包括时机、方案、频率和实验室监测。
在审查了指南的 44 个 PEPFAR 支持国家中，有 66%为高结核病发病率国家；41%被世界卫生组织列为高结核病负担国家，43%为高 HIV 相关结核病负担国家。我们发现，64%（n=28）的国家的国家指南中包含了对孕妇 HIV 感染者的 TB 筛查建议，并且大多数（n=35，80%）国家建议对孕妇 HIV 感染者进行 TPT。提到母乳喂养的国家比提到孕妇的国家少，只有 32%（n=14）提到了 TB 筛查，45%（n=20）专门为这一人群推荐了 TPT；其中大多数建议对孕妇和哺乳期 HIV 感染者使用异烟肼为基础的 TPT 方案。然而，一些国家也建议使用异烟肼联合利福平（3RH）或利福喷丁（3HP）。
尽管在 PEPFAR 支持的国家中，将 TB 筛查和 TPT 建议纳入孕妇和哺乳期 HIV 感染者国家指南的国家数量有所增加，但仍有许多 PEPFAR 支持的国家未为孕妇和哺乳期 HIV 感染者提供具体的筛查和 TPT 建议。
