Improving sputum collection processes to increase tuberculosis case finding among HIV-positive persons in Botswana

Mathebula, Unami; Emerson, Courtney; Agizew, Tefera; Pals, Sherri; Boyd, Rosanna; Mathoma, Anikie; Basotli, Joyce; Rankgoane-Pono, Goabaone; Serumola, Christopher; Date, Anand; Auld, Andrew F.; Finlay, Alyssa

doi:10.5588/pha.19.0051

Cited by 6 publications

(7 citation statements)

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“…Three studies had two distinct interventions [ 22 , 36 , 42 ]. Eighteen studies implemented a standard of care (SOC) strategy alongside an analyzable intervention [ 23 – 25 , 27 – 29 , 31 – 37 , 39 – 41 , 43 , 44 ] ( Table 4 ); effect of the SOC strategy was not analyzed but its concurrent implementation was considered in GRADE certainty assessments.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies implemented co-interventions (i.e., financial support and peer supporters or other dedicated personnel to deliver the educational component) [ 22 , 36 , 42 ]. Remaining studies implemented facility-specific operational improvements as well (e.g., supplemental data collection forms, expedited ART initiation for TB patients diagnosed with HIV) [ 39 , 43 , 44 ].…”

Section: Resultsmentioning

confidence: 99%

“…TB case-detection improved in only one study in Cambodia where newly diagnosed PLHIV were educated about the increased risk of TB by HIV counsellors using a scripted message (RR = 1.53, 95% 1.18–1.98); health care worker training and facility-specific operational improvements were part of the intervention package [ 43 ]. In two other studies implemented at HIV clinics, one in Uganda where group presentations about TB were delivered by peer supporters [ 42 ], and one in Botswana where nurses educated patients on sputum induction techniques [ 44 ], TB case-detection did not improve. ATT initiation also did not improve in the one study reporting on this outcome; the baseline rate was high (94%) [ 42 ].…”

Section: Resultsmentioning

confidence: 99%

“…Several studies described implementation considerations for specific types of interventions. Fourteen studies described general considerations for interventions seeking to link patients to TB and HIV services, which centered on facilities’ and programs’ capacity to absorb increases in new TB and/or HIV diagnoses (laboratory capacity and supply chain management for tests and treatment [ 25 , 26 , 30 , 32 , 37 , 42 , 44 ]), data management (creation of single patient files and data sharing between TB and HIV programs [ 25 , 26 , 31 , 43 ]), human resources (health care worker burden, turnover and shortage [ 23 , 24 , 32 , 37 , 40 , 42 ]), health care worker competencies and perceptions (TB and/or HIV risk misperceptions, reluctance to manage TB and HIV, difficulties diagnosing TB in PLHIV or managing complications such as IRIS, and negative attitudes towards patients [ 25 , 32 , 37 , 40 , 43 ]); and patient perceptions (risk misperceptions, TB and/or HIV stigma, concerns about treatment side effects and clinic commutes to access treatment [ 25 , 42 , 43 ]). For a summary of all implementation barriers and facilitators by outcome, including cost analyses, see S8 File : Implementation Considerations.…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, patient education and counselling about TB-HIV coinfection and financial support improved HIV testing and ART initiation in people with TB [ 22 , 32 , 36 ]. The effect on TB case-detection in PLHIV was mixed but rates of TB testing universally improved in studies implementing patient education and counselling as well as peer support interventions, pointing to critical achievements in the provision and uptake of TB test services [ 42 – 44 ].…”

Section: Discussionmentioning

confidence: 99%

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Interventions to improve linkage along the HIV-tuberculosis care cascades in low- and middle-income countries: A systematic review and meta-analysis

et al. 2022

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Introduction In support of global targets to end HIV/AIDS and tuberculosis (TB) by 2030, we reviewed interventions aiming to improve TB case-detection and anti-TB treatment among people living with HIV (PLHIV) and HIV testing and antiretroviral treatment initiation among people with TB disease in low- and middle-income countries (LMICs). Methods We conducted a systematic review of comparative (quasi-)experimental interventional studies published in Medline or EMBASE between January 2003-July 2021. We performed random-effects effect meta-analyses (DerSimonian and Laird method) for interventions that were homogenous (based on intervention descriptions); for others we narratively synthesized the intervention effect. Studies were assessed using ROBINS-I, Cochrane Risk-of-Bias, and GRADE. (PROSPERO #CRD42018109629). Results Of 21,516 retrieved studies, 23 were included, contributing 53 arms and 84,884 participants from 4 continents. Five interventions were analyzed: co-location of test and/or treatment services; patient education and counselling; dedicated personnel; peer support; and financial support. A majority were implemented in primary health facilities (n = 22) and reported on HIV outcomes in people with TB (n = 18). Service co-location had the most consistent positive effect on HIV testing and treatment initiation among people with TB, and TB case-detection among PLHIV. Other interventions were heterogenous, implemented concurrent with standard-of-care strategies and/or diverse facility-level improvements, and produced mixed effects. Operational system, human resource, and/or laboratory strengthening were common within successful interventions. Most studies had a moderate to serious risk of bias. Conclusions This review provides operational clarity on intervention models that can support early linkages between the TB and HIV care cascades. The findings have supported the World Health Organization 2020 HIV Service Delivery Guidelines update. Further research is needed to evaluate the distinct effect of education and counselling, financial support, and dedicated personnel interventions, and to explore the role of community-based, virtual, and differentiated service delivery models in addressing TB-HIV co-morbidity.

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