Tuberculosis: An important HIV-related complication that must shape HIV care programs in less developed countries
W M El-Sadr, E J Abrams, M Rabkin, B Burman
MTCT-Plus, Mailman School of Public Health, Columbia University, New York, NY, United States
Background: Tuberculosis (TB) is the most common and deadly HIV-related complication in less developed countries (LDC). Thus, its prevention is of key importance. Interactions between antiretroviral therapy (ART) & anti-TB medicines & weak linkages with TB programs complicate HIV management.
Methods: The MTCT-Plus Initiative highlights TB in the context of its HIV programs. Twelve HIV care and treatment programs (including ART) were established in 8 countries in Africa and in Thailand. HIV-infected women, identified through pMTCT, are enrolled with their HIV-infected partners & children. Clinical protocols & ART algorithms were developed with attention to TB. Central procurement includes isoniazid (INH) & tuberculin skin tests (TST). Data collected centrally include TB diagnosis & use of TB drugs. Program directors completed a survey on TB control guidelines/practices & links to TB programs.
Results: Surveys indicated that all sites had access to TB treatment, 9 had directly observed therapy, all faced barriers in links to TB programs & needed training on TB/HIV issues. Two sites used TST and 5 INH preventive therapy (IPT). A TB training module was developed with focus on: rationale for TST and IPT, early diagnosis of TB, choice of ART in context of TB & value of links to TB programs. TB program staff was invited to training. A total of 1,892 persons were enrolled from Feb to Nov 2003:1258 adults & 634 children with 6% of adults and 2% children with current or prior TB. 28% of adults are receiving ART & 16% IPT. Among 32 adults who changed ART, 11 (34%) were due to drug interactions with anti-TB drugs.
Conclusions: TB has substantial impact on HIV care and use of ART. Programs must develop ART algorithms that take into account high TB prevalence, develop TB-specific trainings, support linkages with local TB programs, provide TST and isoniazid for IPT & emphasize importance of early TB diagnosis.
The XV International AIDS Conference
Abstract no. B11428
Suggested Citation
" W M El-Sadr, et al. Tuberculosis: An important HIV-related complication that must shape HIV care programs in less developed countries. CD Only: The XV International AIDS Conference: Abstract no. B11428"