Tuberculosis diagnosis, treatment, and prevention services for children living with HIV in low- and middle-income countries: a multiregional site survey.

IF 2.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of the Pediatric Infectious Diseases Society Pub Date : 2025-05-28 DOI:10.1093/jpids/piaf050

Katherine Laycock, Karl-Günter Technau, Patricia Lelo, Watsamon Jantarabenjakul, Caroline Yonaba, Jorge Pinto, Michael Menser, Fernanda Maruri, Francesca Odhiambo, Ethel Rambiki, Pélagie Babakazo, Nguyen Van Lam, Madeleine Folquet, Daisy Maria Machado, Nelson Kalema, Guy Muula, Ellen Brazier, Nguyen Dinh Qui, Joycelyn Dame, Marco Tulio Luque, Aggrey Semeere, Brian Eley, Marcel Yotebieng, Azar Kariminia, Vanessa Rouzier, Helen Byakwaga, Olivier Marcy, Leslie A Enane

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引用次数: 0

Abstract

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 during September 2020-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 inclusion criteria. Most (90%) reported screening for TB at HIV care enrollment. Access to diagnostics varied significantly by region, including for nucleic acid amplification testing (NAAT, range 67-100%), mycobacterial culture (range 43-83%), and drug susceptibility testing (range 30-82%) (p<0.001). 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=0.008). TPT provision ranged 50-100% (p<0.001). 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 successful outcomes for CLHIV, warranting continued close attention over time and as global TB care guidelines and services evolve.

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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：一项多区域现场调查。

背景：结核病（TB）仍然是感染艾滋病毒（CLHIV）儿童发病和死亡的主要原因，在结核病筛查、诊断、管理和结核病预防治疗（TPT）方面存在差距。我们调查了国际艾滋病流行病学数据库评估（IeDEA）联盟中低收入和中等收入国家（LMICs）的CLHIV护理站点在这些领域的实践报告。方法：我们在2020年9月至2021年2月期间实施了一项现场调查，查询大流行前的做法。该分析包括在2019年诊断出结核病的中低收入国家提供CLHIV护理的站点。我们使用描述性统计分析反应，并使用Fisher精确检验或卡方检验评估区域差异。结果：238个IeDEA站点中，227个（95%）有应答，135个符合纳入标准。大多数（90%）报告在艾滋病毒治疗登记时进行结核病筛查。不同地区的诊断可及性存在显著差异，包括核酸扩增检测（NAAT，范围67-100%）、分枝杆菌培养（范围43-83%）和药敏检测（范围30-82%）。结论：总体报道，在中低收入国家的这些IeDEA站点，NAAT和结核病/艾滋病综合治疗的可及性令人鼓舞，但因环境而异。不同的实施差距仍然存在，特别是在药物敏感性测试、TPT的提供和TPT方案方面，这些差距对CLHIV的成功结果是值得持续密切关注的，随着全球结核病治疗指南和服务的发展。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the Pediatric Infectious Diseases Society Medicine-Pediatrics, Perinatology and Child Health

CiteScore

6.70

自引率

0.00%

发文量

179

期刊介绍： The Journal of the Pediatric Infectious Diseases Society (JPIDS), the official journal of the Pediatric Infectious Diseases Society, is dedicated to perinatal, childhood, and adolescent infectious diseases. The journal is a high-quality source of original research articles, clinical trial reports, guidelines, and topical reviews, with particular attention to the interests and needs of the global pediatric infectious diseases communities.