Quality of TB care among people living with HIV: Gaps and solutions

Abstract

Tuberculosis (TB) is the leading infectious cause of death among people living with HIV, causing one third of AIDS-related deaths globally. The concerning number of missing TB cases, ongoing high TB mortality, slow reduction in TB incidence, and limited uptake of TB preventive treatment among people living with HIV, all indicate the urgent need to improve quality of TB services within HIV programs. In this mini-review we discuss major gaps in quality of TB care that impede achieving prevention and treatment targets within the TB-HIV care cascades, show approaches of assessing gaps in TB service provision, and describe outcomes from innovative quality improvement projects among HIV and TB programs. We also offer recommendations for measuring quality of TB care.

Engaging Community Pharmacies in Early Detection of Missing Tuberculosis Patients through Public–Private Mix Intervention in Pakistan

“…20,21 Given the substantial contribution of PPM-1, 13 and the large estimates of community pharmacies providing TB medications without prescription, 14 a possible way to increase TB case detection rates and guideline-adherent TB care offered at private facilities may be to bring community pharmacies into the folds of the PPM-1 model. 22 Based on this rationale, we designed a study to enhance the early case detection of missing TB cases within the Pakistani healthcare system by involving private pharmacies with private general practitioners and laboratories (conventional PPM-1) in a novel approach (PPM-1 boosted). The mechanism of operation of this novel model was the development of a formalized referral pathway for patients seeking TB care at pharmacies.…”

Addressing TB-related mortality in adults living with HIV: a review of the challenges and potential solutions

“…Barriers to healthcare engagement at each stage of the HIV/TB cascade of care impact the quality of care and can adversely affect all outcomes, including mortality. 20 A systematic review found that the main factors that affected initial engagement by Indian patients with TB care were not recognizing symptoms as severe enough to seek medical attention, work pressure, dissatisfaction with nearby health facility, lack of proximity to a healthcare facility, financial constraints, alcohol dependence, and inconvenient working hours. 21 A systematic review reported that barriers to healthcare engagement among Ethiopian presumptive TB patients included short duration of cough, absence of previous TB treatment history, lack of money, old age, low education level, lack of jobs, perceived wellness, and use of traditional healers.…”

“… 23 Barriers to healthcare engagement such as stigma are often intersectional and compounded in PLHIV compared with people without HIV (dual stigma for people with HIV/TB co-infection), and also highlight broader health system weaknesses, such as inefficient care delivery processes, gaps in data communication, and infrastructure. 20 …”

“…A nested observational cohort study evaluating unselected hospitalized PLHIV in Malawi found that 32% of those on ART for at least 6 months had virological failure, the majority of whom (83%) had resistance to at least two ART drugs, which was associated with increased mortality (adjusted hazard ratio 1.7, 95% CI: 1.2 to 2.4; p = 0.0042). 20 , 56 …”

“… 75 There is an urgent need to increase health system resources to improve healthcare infrastructure, integration of TB and HIV healthcare, and enable person-centered care that addresses socioeconomic constraints such as food insecurity and lack of transportation. 20 …”