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

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dc.contributor.affiliationLighthouse Clinic Trust, Lilongwe, Malawi.
dc.contributor.affiliationThe Kirby Institute, UNSW Sydney, Australia.
dc.contributor.affiliationKalembelembe Pediatric Hospital, Unit of Infectious Diseases, Kinshasa, Democratic Republic of Congo.
dc.contributor.affiliationCHU Cocody, Service Pédiatrie, Abidjan, Côte d'Ivoire.
dc.contributor.affiliationCenter of Excellence for Pediatric Infectious Diseases and Vaccines, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
dc.contributor.affiliationRed Cross War Memorial Children's Hospital and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
dc.contributor.affiliationPediatric Department, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
dc.contributor.affiliationInfectious Diseases Department, Children's Hospital 2, Ho Chi Minh City, Vietnam.
dc.contributor.affiliationInfectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
dc.contributor.affiliationKinshasa School of Public Health, Democratic Republic of Congo.
dc.contributor.affiliationEmpilweni 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.
dc.contributor.affiliationUniversity of Ghana Medical School and Korle Bu Teaching Hospital, Accra Ghana.
dc.contributor.affiliationCenter for Infectious Disease Research in Zambia, Lusaka, Zambia.
dc.contributor.affiliationInstituto Hondureño de Seguridad Social, Tegucigalpa, Honduras.
dc.contributor.affiliationIndiana University Department of Biostatistics and Health Data Science, Indianapolis, United States.
dc.contributor.affiliationIndiana University Center for Global Health Equity, Indianapolis, United States.
dc.contributor.affiliationThe Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, United States.
dc.contributor.affiliationCenter for Tropical Diseases, Vietnam National Children's Hospital, Hanoi, Vietnam.
dc.contributor.affiliationFederal University of Minas Gerais, Belo Horizonte, Brazil.
dc.contributor.affiliationCity University of New York, Institute for Implementation Science in Population Health, New York, United States.
dc.contributor.affiliationDivision of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, The Bronx, New York, United States.
dc.contributor.affiliationMbarara University of Science and Technology, Mbarara, Uganda.
dc.contributor.affiliationFamily AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya.
dc.contributor.affiliationUniversity of Bordeaux, Inserm U1219 Bordeaux Population Health, IRD EMR271 GHiGS, Bordeaux, France.
dc.contributor.affiliationDivision of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, United States.
dc.contributor.affiliationLes Centres GHESKIO, Port-au-Prince, Haiti.
dc.contributor.affiliationEscola Paulista de Medicina - Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.
dc.contributor.affiliationCIDRZ
dc.contributor.affiliationCentre for Infectious Disease Research in Zambia (CIDRZ)
dc.contributor.authorLaycock K
dc.contributor.authorTechnau KG
dc.contributor.authorLelo P
dc.contributor.authorJantarabenjakul W
dc.contributor.authorYonaba C
dc.contributor.authorPinto J
dc.contributor.authorMenser M
dc.contributor.authorMaruri F
dc.contributor.authorOdhiambo F
dc.contributor.authorRambiki E
dc.contributor.authorBabakazo P
dc.contributor.authorVan Lam N
dc.contributor.authorFolquet M
dc.contributor.authorMachado DM
dc.contributor.authorKalema N
dc.contributor.authorMuula G
dc.contributor.authorBrazier E
dc.contributor.authorDinh Qui N
dc.contributor.authorDame J
dc.contributor.authorLuque MT
dc.contributor.authorSemeere A
dc.contributor.authorEley B
dc.contributor.authorYotebieng M
dc.contributor.authorKariminia A
dc.contributor.authorRouzier V
dc.contributor.authorByakwaga H
dc.contributor.authorMarcy O
dc.contributor.authorEnane LA
dc.date.accessioned2025-07-10T11:06:27Z
dc.date.issued2025-May-28
dc.description.abstractBACKGROUND: 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.
dc.identifier.doi10.1093/jpids/piaf050
dc.identifier.urihttps://pubs.cidrz.org/handle/123456789/10830
dc.identifier.uri.pubmedhttps://pubmed.ncbi.nlm.nih.gov/40425522/
dc.sourceJournal of the Pediatric Infectious Diseases Society
dc.titleTuberculosis diagnosis, treatment, and prevention services for children living with HIV in low- and middle-income countries: a multiregional site survey.

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