低收入和中等收入国家感染艾滋病毒儿童的结核病诊断、治疗和预防服务：一项多区域实地调查
Tuberculosis Diagnosis, Treatment, and Prevention Services for Children Living with HIV in Low- and Middle-Income Countries: A Multiregional Site Survey.
作者信息
Laycock Katherine, Technau Karl-Günter, Lelo Patricia, Jantarabenjakul Watsamon, Yonaba Caroline, Pinto Jorge, Menser Michael, Maruri Fernanda, Odhiambo Francesca, Rambiki Ethel, Babakazo Pélagie, Nguyen Van Lam, Folquet Madeleine, Machado Daisy Maria, Kalema Nelson, Muula Guy, Brazier Ellen, Nguyen Dinh Qui, Dame Joycelyn, Luque Marco Tulio, Semeere Aggrey, Eley Brian, Yotebieng Marcel, Kariminia Azar, Rouzier Vanessa, Byakwaga Helen, Marcy Olivier, Enane Leslie A
机构信息
The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, IN, United States.
Empilweni Services and Research Unit (ESRU), Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa.
出版信息
J Pediatric Infect Dis Soc. 2025 Jun 16;14(6). doi: 10.1093/jpids/piaf050.
BACKGROUND
Tuberculosis (TB) remains a leading cause of morbidity and mortality for children living with HIV (CLHIV), with gaps in TB screening, diagnostics, management, and TB preventive therapy (TPT). We investigated reported practices in these domains at sites caring for CLHIV in low- and middle-income countries (LMICs) within the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium.
METHODS
We implemented a site survey from September 2020 to February 2021, querying pre-pandemic practices. This analysis included sites in LMICs providing care for CLHIV that diagnosed TB in 2019. We analyzed responses using descriptive statistics and assessed regional differences using Fisher's exact or chi-square tests.
RESULTS
Of 238 IeDEA sites, 227 (95%) responded and 135 met the inclusion criteria. Most (90%) reported screening for TB at HIV care enrollment. Access to diagnostics varied significantly by region, including nucleic acid amplification testing (NAAT, range 67-100%), mycobacterial culture (range 43%-83%), and drug susceptibility testing (range 30%-82%) (P < .001). On-site TB treatment was high (90%). Reported stock-outs occurred for isoniazid (23/116, 20%) and other TB medications (11/114, 9.6%, range 0%-33%, P = .008). TPT provision ranged 50%-100% (P < .001). Six months of isoniazid was the most common TPT regimen for children (88%). Shorter TPT regimens were uncommon (0.9%-2.8%), as were regimens for multidrug-resistant TB exposure (4.6%).
CONCLUSIONS
Overall reported availability of NAAT and integrated TB/HIV treatment for CLHIV cared for at these IeDEA sites in LMICs is encouraging but varies by context. Heterogeneous implementation gaps remain-particularly for drug susceptibility testing, TPT delivery, and TPT regimens-which may impede TB prevention, management, and successful outcomes for CLHIV, warranting continued close attention over time and as global TB care guidelines and services evolve.
背景
结核病（TB）仍然是感染艾滋病毒儿童（CLHIV）发病和死亡的主要原因，在结核病筛查、诊断、管理以及结核病预防性治疗（TPT）方面存在差距。我们调查了国际流行病学数据库评估艾滋病（IeDEA）联盟中低收入和中等收入国家（LMICs）为CLHIV提供护理的场所中这些领域的报告做法。
方法
我们在2020年9月至2021年2月期间进行了一次场所调查，询问疫情前的做法。该分析包括2019年为CLHIV提供护理并诊断出结核病的LMICs中的场所。我们使用描述性统计分析回复，并使用Fisher精确检验或卡方检验评估区域差异。
结果
在238个IeDEA场所中，227个（95%）做出了回应，135个符合纳入标准。大多数（90%）报告在艾滋病毒护理登记时进行结核病筛查。诊断方法的可及性因地区而异，包括核酸扩增检测（NAAT，范围67%-100%）、分枝杆菌培养（范围43%-83%）和药敏试验（范围30%-82%）（P<0.001）。现场结核病治疗率很高（90%）。报告显示异烟肼（23/116，20%）和其他结核病药物（11/114，9.6%，范围0%-33%，P=0.008）出现缺货情况。TPT的提供率在50%-100%之间（P<0.001）。六个月的异烟肼是儿童最常见的TPT方案（88%）。较短疗程的TPT方案不常见（0.9%-2.8%），耐多药结核病暴露的方案也不常见（4.6%）。
结论
总体而言，在这些LMICs的IeDEA场所中，报告的CLHIV的NAAT可用性和结核病/艾滋病毒综合治疗情况令人鼓舞，但因情况而异。仍然存在不同的实施差距，特别是在药敏试验、TPT提供和TPT方案方面，这可能会阻碍CLHIV的结核病预防、管理和成功治疗结果，随着时间的推移以及全球结核病护理指南和服务的演变，需要持续密切关注。
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