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1. Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy: The IeDEA-West Africa HIV-2 Cohort Study.

Author

Ekouevi DK, Balestre E, Coffie PA, Minta D, Messou E, Sawadogo A, Minga A, Sow PS, Bissagnene E, Eholie SP, Gottlieb GS, Dabis F, Zannou DM, Ahouada C, Akakpo J, Ahomadegbé C, Bashi J, Gougounon-Houéto A, Azon-Kouanou A, Houngbé F, Koumakpaï S, Alihonou F, d'Almeida M, Hodonou I, Hounhoui G, Sagbo G, Tossa-Bagnan L, Adjide H, Drabo J, Bognounou R, Dienderé A, Traore E, Zoungrana L, Zerbo B, Sawadogo AB, Zoungrana J, Héma A, Soré I, Bado G, Tapsoba A, Yé D, Kouéta F, Ouedraogo S, Ouédraogo R, Hiembo W, Gansonré M, Messou E, Gnokoro JC, Koné M, Kouakou GM, Bosse CA, Brou K, Assi AI, Chenal H, Hawerlander D, Soppi F, Minga A, Abo Y, Bomisso G, Eholié SP, Amego MD, Andavi V, Diallo Z, Ello F, Tanon AK, Koule SO, Anzan KC, Guehi C, Aka EA, Issouf KL, Kouakou JC, N'gbeche MS, Touré P, Avit-Edi D, Kouakou K, Moh M, Yao VA, Folquet MA, Dainguy ME, Kouakou C, Méa-Assande VT, Oka-Berete G, Zobo N, Acquah P, Kokora MB, Eboua TF, Timité-Konan M, Ahoussou LD, Assouan JK, Sami MF, Kouadio C, Renner L, Goka B, Welbeck J, Sackey A, Owiafe SN, Wejse C, Silva ZJ, Paulo J, Rodrigues A, da Silva D, Medina C, Oliviera-Souto I, Ostergaard L, Laursen A, Sodemann M, Aaby P, Fomsgaard A, Erikstrup C, Eugen-Olsen J, Maïga MY, Diakité FF, Kalle A, Katile D, Traore HA, Minta D, Cissé T, Dembelé M, Doumbia M, Fomba M, Kaya AS, Traoré AM, Traoré H, Toure AA, Dicko F, Sylla M, Berthé A, Traoré HC, Koïta A, Koné N, N'diaye C, Coulibaly ST, Traoré M, Traoré N, Charurat M, Ajayi S, Dapiap S, Otu, Igbinoba F, Benson O, Adebamowo C, James J, Obaseki, Osakede P, Olasode J, Sow PS, Diop B, Manga NM, Tine JM, Signate Sy H, Ba A, Diagne A, Dior H, Faye M, Gueye RD, Mbaye AD, Patassi A, Kotosso A, Kariyare BG, Gbadamassi G, Komi A, Mensah-Zukong KE, Pakpame P, Lawson-Evi AK, Atakouma Y, Takassi E, Djeha A, Ephoévi-Gah A, Djibril Sel-H, Dabis F, Bissagnene E, Arrivé E, Coffie P, Ekouevi D, Jaquet A, Leroy V, Lewden C, Sasco A, Azani JC, Allou G, Balestre E, Bohossou F, Karcher S, Gonsan JM, Carrou JL, Lenaud S, Nchot C, Malateste K, Yao AR, Siloué B, Clouet G, Djetouan H, Doring A, Kouakou A, Rabourdin E, Rivenc J, Anglaret X, Ba B, Essanin JB, Ciaranello A, Datté S, Desmonde S, Diby JS, Gottlieb GS, Horo AG, Kangah SN, Malvy D, Meless D, Mounkaila-Harouna A, Ndondoki C, Shiboski C, Thiébaut R, Pac-Ci, and Abidjan

Subjects
Adult, Africa, Western epidemiology, Cohort Studies, Female, HIV Infections virology, Humans, Male, Middle Aged, Anti-HIV Agents therapeutic use, HIV Infections drug therapy, HIV-1 isolation & purification, HIV-2 isolation & purification
Abstract

Background: HIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART) for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework of the International epidemiological Databases to Evaluate AIDS (IeDEA)., Methods: We collected data on all HIV-2 and HIV-1/HIV-2 dually seropositive patients (both ARV-naive and starting ART) and followed-up in clinical centres in the IeDEA-WA network including a total of 13 clinics in five countries: Benin, Burkina-Faso Côte d'Ivoire, Mali, and Senegal, in the West Africa region., Results: Data was merged for 1,754 patients (56% female), including 1,021 HIV-2 infected patients (551 on ART) and 733 dually seropositive for both HIV-1 and HIV 2 (463 on ART). At ART initiation, the median age of HIV-2 patients was 45.3 years, IQR: (38.3-51.7) and 42.4 years, IQR (37.0-47.3) for dually seropositive patients (p = 0.048). Overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C). The median CD4 count at the ART initiation is 166 cells/mm(3), IQR (83-247) among HIV-2 infected patients and 146 cells/mm(3), IQR (55-249) among dually seropositive patients. Overall, in ART-treated patients, the CD4 count increased 126 cells/mm(3) after 24 months on ART for HIV-2 patients and 169 cells/mm(3) for dually seropositive patients. Of 551 HIV-2 patients on ART, 5.8% died and 10.2% were lost to follow-up during the median time on ART of 2.4 years, IQR (0.7-4.3)., Conclusions: This large multi-country study of HIV-2 and HIV-1/HIV-2 dual infection in West Africa suggests that routine clinical care is less than optimal and that management and treatment of HIV-2 could be further informed by ongoing studies and randomized clinical trials in this population.

Published
2013
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2. Implementation of Tuberculosis Intensive Case Finding, Isoniazid Preventive Therapy, and Infection Control ('Three I's') and HIV-Tuberculosis Service Integration in Lower Income Countries

Author

Charles, M.K., Lindegren, M.L., Wester, C.W., Blevins, M., Sterling, T.R., Dung, N.T., Dusingize, J.C., Avit-Edi, D., Durier, N., Castelnuovo, B., Nakigozi, G., Cortes, C.P., Ballif, M., Fenner, L., Ajayi, S., Anastos, K., Bashi, J., Bishai, W., Boulle, A., Braitstein, P., Carriquiry, G., Carter, J.E., Cegielski, P., Chimbetete, C., Davies, M.-A., Diero, L., Duda, S., Egger, M., Eboua, T.F., Gasser, A., Geng, E., Gnokori, J.C., Hardwicke, L., Hoffmann, C., Huebner, R., Kancheya, N., Kiertiburanakul, S., Kim, P., Lameck, D., Leroy, V., Lewden, C., Mandalakas, A., Maskew, M., McKaig, R., Mofenson, L., Mpoudi-Etame, M., Okwara, B., Phiri, S., Prasitsuebsai, W., Petit, A., Prozesky, H., Reid, S.E., Renner, L., Reubenson, G., Sohn, A., Vo, Q., Walker, D., Wehbe, F., Wejse, C., Williams, C., Wood, R., Wools-Kaloustian, K., Yao, Z., Yunihastuti, E., Zhang, F.J., Zhao, H.X., Han, N., Merati, T.P., Wirawan, D.N., Yuliana, F., Ditangco, R., Uy, E., Bantique, R., Phanuphak, P., Ruxrungtham, K., Avihingsanon, A., Khongphattanayothin, M., Sungkanuparph, S., Sanmeema, N., Chaiwarith, R., Sirisanthana, T., Kotarathititum, W., Pham, T.T., Cuong, D.D., Ha, H.L., Nguyen, V.K., Bui, V.H., Nguyen, T.D., Sohn, A.H., Petersen, B., Cooper, D.A., Law, M.G., Jiamsakul, A., Boettiger, D.C., Wati, D.K., Atmikasari, L.P.P., Malino, I.Y., Nallusamy, R., Chan, K.C., Lumbiganon, P., Kosalaraksa, P., Tharnprisan, P., Udomphanit, T., Phongsamart, W., Wittawatmongkol, O., Dung, K.T.K., Lam, N.V., An, P.N., Loan, N.T., Truong, H.K., Du, T.Q., Chau, N.H., Do, C.V., Ha, M.T., Nipathakosol, P., Kariminia, A., Mutimura, E., Gitembagara, A., Tatwangire, J., Izabelle, I., Niyongabo, T., Twizere, C., Baramperanye, E., Edmonds, A., Yotebieng, M., Azinyue, I., Ayangma, L., Dickinson, D., Eley, B., Fritz, C., Garone, D., Giddy, J., MacPhail, P., Moultrie, H., Ndirangu, J., Pestilli, S., Rabie, H., Stringer, J., Technau, K., Graber, C., Kaeser, F., Keiser, O., Cornell, M., Maxwell, N., Zannou, D.M., Ahouada, C., Akakpo, J., Ahomadegbé, C., Gougounon-Houéto, A., Azon-Kouanou, A., Houngbé, F., Sehonou, J., Koumakpaï, S., Alihonou, F., D'Almeida, M., Hodonou, I., Hounhoui, G., Sagbo, G., Tossa-Bagnan, L., Adjide, H., Drabo, J., Bognounou, R., Dienderé, A., Traore, E., Zoungrana, L., Zerbo, B., Sawadogo, A.B., Zoungrana, J., Héma, A., Soré, I., Bado, G., Tapsoba, A., Yé, D., Kouéta, F., Ouedraogo, S., Ouédraogo, R., Hiembo, W., Gansonré, M., Messou, E., Gnokoro, J.C., Koné, M., Kouakou, G.M., Bosse, C.A., Brou, K., Assi, A.I., Chenal, H., Hawerlander, D., Soppi, F., Minga, A., Abo, Y., Yoboue, J.-M., Eholié, S.P., Amego, M.D.N., Andavi, V., Diallo, Z., Ello, F., Tanon, A.K., Koule, S.O., Anzan, K.C., Guehi, C., Aka, E.A., Issouf, K.L., Kouakou, J.-C., N'Gbeche, M.-S., Pety, T., Kouakou, K., Moh, M., Yao, V.A., Folquet, M.A., Dainguy, M.-E., Kouakou, C., Méa-Assande, V.T., Oka-Berete, G., Zobo, N., Acquah, P., Kokora, M.-B., Timité-Konan, M., Ahoussou, L.D., Assouan, J.K., Sami, M.F., Kouadio, C., Goka, B., Welbeck, J., Sackey, A., Owiafe, S.N., Da Silva, Z.J., Paulo, J., Rodrigues, A., Da Silva, D., Medina, C., Oliviera-Souto, I., Østergaard, L., Laursen, A., Sodemann, M., Aaby, P., Fomsgaard, A., Erikstrup, C., Eugen-Olsen, J., Maïga, M.Y., Diakité, F.F., Kalle, A., Katile, D., Traore, H.A., Minta, D., Cissé, T., Dembelé, M., Doumbia, M., Fomba, M., Kaya, A.S., Traoré, A.M., Traoré, H., Toure, A.A., Dicko, F., Sylla, M., Berthé, A., Traoré, H.C., Koïta, A., Koné, N., N'Diaye, C., Coulibaly, S.T., Traoré, M., Traoré, N., Charurat, M., Alim, G., Dapiap, S., Otu, Igbinoba, F., Benson, O., Adebamowo, C., James, J., Obaseki, Osakede, P., Olasode, J., Seydi, M., Sow, P.S., Diop, B., Manga, N.M., Tine, J.M., Bassabi, C.C., Sy, H.S., Ba, A., Diagne, A., Dior, H., Faye, M., Gueye, R.D., Mbaye, A.D., Patassi, A., Kotosso, A., Kariyare, B.G., Gbadamassi, G., Komi, A., Mensah-Zukong, K.E., Pakpame, P., Lawson-Evi, A.K., Atakouma, Y., Takassi, E., Djeha, A., Ephoévigah, A., Djibril, S.E.-H., Dabis, F., Bissagnene, E., Arrivé, E., Coffie, P., Ekouevi, D., Jaquet, A., Sasco, A.J., Amani, D., Azani, J.-C., Balestre, E., Bessekon, S., Bohossou, F., Gilbert, C., Karcher, S., Gonsan, J.M., Le Carrou, J., Lenaud, S., Nchot, C., Malateste, K., Yao, A.R., Siloué, B., Clouet, G., Dosso, M., Doring, A., Kouakou, A., Rabourdin, E., Rivenc, J., Anglaret, X., Ba, B., Essanin, J.B., Ciaranello, A., Datté, S., Desmonde, S., Diby, J.-S.E., Gottlieb, G.S., Horo, A.G., Kangah, S.N., Malvy, D., Meless, D., Mounkaila-Harouna, A., Ndondoki, C., Shiboski, C., Tchounga, B., Thiébaut, R., Wandeler, G., McGowan, C., Cahn, P., Gotuzzo Herencia, José Eduardo, Reyes, M.W., Grinsztejn, B., Pape, J.W., Padgett, D., and Madero, J.S.

Subjects
0301 basic medicine, Program evaluation, Bacterial Diseases, poverty, Physiology, Antitubercular Agents, lcsh:Medicine, HIV Infections, Pathology and Laboratory Medicine, Occupational safety and health, Geographical Locations, 0302 clinical medicine, case finding, Health care, lowest income group, Medicine and Health Sciences, Coughing, Medicine, Infection control, 030212 general & internal medicine, lcsh:Science, fever, Multidisciplinary, antiretrovirus agent, adult, HIV diagnosis and management, sputum smear, Vaccination and Immunization, 3. Good health, Infectious Diseases, Caribbean Region, Tuberculosis Diagnosis and Management, protective equipment, tuberculosis control, Research Article, medicine.medical_specialty, isoniazid, Tuberculosis, Asia, integrated health care system, 030106 microbiology, HIV prevention, Immunology, Developing country, Antiretroviral Therapy, complication, 610 Medicine & health, World Health Organization, Article, 03 medical and health sciences, Signs and Symptoms, Tuberculosis diagnosis, Antiviral Therapy, Human immunodeficiency virus infection, night sweat, 360 Social problems & social services, Environmental health, parasitic diseases, Isoniazid, Humans, purl.org/pe-repo/ocde/ford#3.01.05 [https], human, coughing, Poverty, tuberculin test, Caribbean, Preventive medicine, Infection Control, AIDS-Related Opportunistic Infections, business.industry, screening, lcsh:R, Biology and Life Sciences, occupational safety, South America, medicine.disease, Tropical Diseases, Diagnostic medicine, mask, Public and occupational health, purl.org/pe-repo/ocde/ford#3.02.07 [https], People and Places, Africa, Physical therapy, tuberculostatic agent, lcsh:Q, weight reduction, business, Physiological Processes
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 Africa. RESULTS 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 positive 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 integrated HIV-TB services. Integration was not associated with implementation of TB prevention 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.

Published
2016
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3. Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries

Author

I. Izabelle, F. Ello, H. Ssemuwemba, S. Phiri, J. Olasode, Marie-Sylvie N’Gbeche, S. Kouadio, Jesper Eugen-Olsen, M. Mpoudi-Etame, Cristin Q. Fritz, S. Dapiap, J. Zoungrana, Antoine Jaquet, Aristophane Tanon, Rasmata Ouédraogo, N. T. Loan, E. J. Carter, Obaseki, F. F. Diakité, H. X. Zhao, Kulkanya Chokephaibulkit, Z. J. da Silva, Peter Aaby, Dewi Kumara Wati, David da Silva, L. Ayangma, K. Jjingo, P. Kim, Romanee Chaiwarith, James Ndirangu, Valériane Leroy, L. P. P. Atmikasari, N. Zobo, H. Chenal, Rita Lyamuya, Catherine C. McGowan, Keswadee Lapphra, Wanatpreeya Phongsamart, B. B. Mwebesa, Théodore Niyongabo, D. Katile, B. Ba, Matthias Egger, L. Mofenson, A. Mounkaila-Harouna, Boris Tchounga, M. Moh, Elom Takassi, Haby Signaté Sy, G. Sagbo, F. Kaeser, Eduardo Gotuzzo, Guillaume Bado, C. C. McGowan, S. Karcher, Constantin T. Yiannoutsos, V. H. Bui, Christopher J. Hoffmann, Didier K. Ekouevi, J. Akakpo, I. Azinyue, S. Kiertiburanakul, S. O. Koule, W. Bishai, Mariam Guindo Traoré, C. Williams, Elise Arrivé, A. Tapsoba, S. Bessekon, Patrick A. Coffie, F. Yuliana, A. Gougounon-Houéto, Somnuek Sungkanuparph, Y. Abo, Q. Vo, Praphan Phanuphak, M. B. Kokora, Kouadio Kouakou, Fla Kouéta, M. E. Dainguy, O. Benson, I. Soré, W. Prasitsuebsai, Harry Moultrie, C. Guehi, Beatriz Grinsztejn, T. Q. Du, L. Diecket Ahoussou, Z. Diallo, N. Traoré, Firas Wehbe, C. V. Do, J. Tatwangire, A. Kotosso, F. Soppi, Amabelia Rodrigues, Juan Sierra Madero, P. S. Sow, Rodolphe Thiébaut, I. Y. Malino, Moussa Seydi, Helena Rabie, A. Dienderé, Geoffrey Somi, Emmanuel Bissagnene, Elizabeth A. Bukusi, H. C. Traoré, David A. Cooper, N. M. Manga, P. Osakede, S. Ajayi, J. Paulo, Marguerite Timite-Konan, Andrew Edmonds, B. Diop, A. M. Traoré, W. Hiembo, A. Koïta, M. Faye, A. Azon-Kouanou, Christian Wejse, Claudia P. Cortes, T. Pety, N. Durier, Thira Sirisanthana, Camille Ndondoki, Karl-Günter Technau, J. S. Elvis Diby, G. Alim, M. D'Almeida, A. Komi, J. Bashi, J. M. Tine, D. Hawerlander, R. Ditangco, Akouda Patassi, A. Kalle, F. J. Zhang, Lorna Renner, N. H. Chau, Janet Giddy, G. Clouet, Samwel O. Ayaya, A. Sohn, Lars Østergaard, Sylvie Ouédraogo, Clement Adebamowo, Azar Kariminia, John Ssali, Joseph Drabo, M. Dembelé, Nicola Maxwell, Albert Minga, M. D.N. Amego, Wilai Kotarathititum, Christian Erikstrup, H. A. Traore, Kapella Zacharia Ngonyani, E. Geng, Lukas Fenner, A. Diagne, Marcelo Wolff, A. I. Assi, A. Sackey, A. R. Yao, M. F. Sami, Edmond Addi Aka, H. Adjide, Pagakrong Lumbiganon, Karen Malateste, L. Diero, M. Gansonré, P. N. An, A. H. Sohn, D. Meless, D. Avit-Edi, D. Walker, L. Hardwicke, A. S. Kaya, Véronique Mea-Assande, G. S. Gottlieb, Denis Padgett, Eric Balestre, Candida Medina, D. Amani, C. Kouakou, C. Shiboski, E Messou, B. G. Kariyare, M. Ballif, W. Wester, J. M. Gonsan, G. Gbadamassi, A. Ba, M. Fomba, Denis Malvy, R. Bantique, S. N. Owiafe, Andrew Kambugu, Festus Igbinoba, M. Y. Maiga, C. Ahomadegbé, A. Berthé, R. D. Gueye, C. C. Bassabi, Djimon Marcel Zannou, Olivia Keiser, Kara Wools-Kaloustian, K. E. Mensah-Zukong, A. Doring, C. Chimbetete, J. Rivenc, V. Andavi, F. Alihonou, S. Datté, S. Pestilli, T. Mengthaisong, Kathryn Anastos, A. D. Mbaye, D. Lameck, Claire Graber, J. Lewis-Kulzer, G. Reubenson, B. Siloué, Marcel Yotebieng, K. T.K. Dung, C. Ahouada, Severin Lenaud, J. Welbeck, D. Dickinsonn, L. Zoungrana, A. Avihingsanon, T. T. Cao, V. K. Nguyen, Morten Sodemann, J. C. Dusingize, B. Okwara, C. Lewden, H. Traoré, Patrick MacPhail, David C Boettiger, G. Oka-Berete, H. K. Truong, F. Houngbé, Robin Wood, Venerandah Nhandu, J. C. Azani, G. Wandeler, K. L. Issouf, K. C. Anzan, Andrea L. Ciaranello, Awachana Jiamsakul, M. T. Ha, K. Brou, M. Maskew, L. Tossa-Bagnan, B. Zerbo, P. Pakpame, Xavier Anglaret, Jean W. Pape, J. B. Essanin, A. Petit, A. Kouakou, E. Rabourdin, Orasri Wittawatmongkol, Daniela Garone, S. El-Hadj Djibril, S. Duda, C. Twizere, K. C. Chan, Annie J. Sasco, N. Sanmeema, N. V. Lam, J. Conrad, Q. T. Du, P. Tharnprisan, Z. Yao, A. Djeha, Siriatou A. Koumakpai, Joachim Gnokoro, I. Hodonou, Sabine Hermans, Timothy R. Sterling, C. Nchot, D. Minta, E. Yunihastuti, T. F. Eboua, T. Cissé, Revathy Nallusamy, Jeffrey S. A. Stringer, Dabis F, F. Bohossou, Brian Eley, E. Traore, R. McKaig, Matthew Law, Manhattan Charurat, G. M. Kouakou, Madeleine Amorissani Folquet, A. Mandalakas, Sophie Desmonde, S. Eholié, J. K. Assouan, Andrew Boulle, Tuti Parwati Merati, A. Koko Lawson-Evi, Eugene Mutimura, C. A. Bosse, M Dosso, Fred Nalugoda, T. T. Pham, T. Udomphanit, H. L. Ha, N. Kancheya, N. Han, J. Sehonou, S. N. Kangah, R. Huebner, A. Gasser, C. Gilbert, Appolinaire Horo, J. C. Kouakou, D. Yé, P. Acquah, A. Héma, Pope Kosalaraksa, Hans Prozesky, J. James, Fatoumata Dicko, P. Cahn, Moussa Doumbia, I. Oliviera-Souto, Morna Cornell, Elenore Judy B. Uy, G. Hounhoui, J. E. Carter, V. A. Yao, Adrien Sawadogo, B. Petersen, S. E. Reid, B. Goka, G. Carriquiry, M. A. Davies, P. Nipathakosol, J. Le Carrou, M. L. Lindegren, H. Dior, P. Cegielski, E. Baramperanye, Mariam Sylla, Anders Fomsgaard, P. Braitstein, S. T. Coulibaly, D. D. Cuong, C. N'Diaye, M. Kone, Dewa Nyoman Wirawan, A. Gitembagara, Niaboula Koné, K. Ruxrungtham, R. Bognounou, Aissatou Touré, A. Ephoévi-gah, Alex Lund Laursen, and Y. Atakouma

Subjects
Male, Questionnaires, West African, Pediatrics, Asia Pacific, Antitubercular Agents, HIV Infections, Drug resistance, rifampicin, South Africa, drug resistant tuberculosis, Surveys and Questionnaires, Tuberculosis, Multidrug-Resistant, Central Africa, antiretrovirus agent, Human immunodeficiency virus infected patient, clinical practice, microbial sensitivity test, Infectious Diseases, priority journal, urban population, Female, anti human immunodeficiency virus agent, supply and distribution, medicine.drug, Pulmonary and Respiratory Medicine, Adult, isoniazid, medicine.medical_specialty, Tuberculosis, Asia, phenotype, Anti-HIV Agents, Developing country, MDR-TB, Microbial Sensitivity Tests, purl.org/pe-repo/ocde/ford#3.03.08 [https], preventive medicine, Article, South and Central America, socioeconomics, medicine, Humans, controlled study, human, rural population, drug sensitivity, Developing Countries, Directly Observed Therapy, Preventive healthcare, ART programs, Caribbean, business.industry, questionnaire, Drug resistant tuberculosis, developing country, CD4 lymphocyte count, Central africa, Central America, South America, medicine.disease, major clinical study, Latin America, purl.org/pe-repo/ocde/ford#3.02.07 [https], Africa, world health organization, tuberculostatic agent, business, Rifampicin
Abstract

SETTING: Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons.OBJECTIVE: To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries.DESIGN: We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n = 14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n = 6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs.RESULTS: Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages.CONCLUSIONS: Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower-income countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.

Published
2014
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