Abstract:
Setting
World Health Organization advocates for integration of HIV-tuberculosis (TB) services and
recommends intensive case finding (ICF), isoniazid preventive therapy (IPT), and infection
control (
“
Three I
’
s
”
) for TB prevention and control among persons living with HIV.
Objective
To assess the implementation of the
“
Three I
’
s
”
of TB-control at HIV treatment sites in lower
income countries.
Design
Survey conducted between March-July, 2012 at 47 sites in 26 countries: 6 (13%) Asia
Pacific, 7 (15%), Caribbean, Central and South America, 5 (10%) Central Africa, 8 (17%)
East Africa, 14 (30%) Southern Africa, and 7 (15%) West AfricaResults
ICF using symptom-based screening was performed at 38% of sites; 45% of sites used
symptom-screening plus additional diagnostics. IPT at enrollment or ART initiation was
implemented in only 17% of sites, with 9% of sites providing IPT to tuberculin-skin-test posi-
tive patients. Infection control measures varied: 62% of sites separated smear-positive
patients, and healthcare workers used masks at 57% of sites. Only 12 (26%) sites inte-
grated HIV-TB services. Integration was not associated with implementation of TB preven-
tion measures except for IPT provision at enrollment (42% integrated vs. 9% non-
integrated; p = 0.03).
Conclusions
Implementation of TB screening, IPT provision, and infection control measures was low and
variable across regional HIV treatment sites, regardless of integration status.
