Tuberculosis Infection Control in Resource‐Limited Settings in the Era of Expanding HIV Care and Treatment

Abstract

The opportunities for human immunodeficiency virus (HIV) care and treatment created by new treatment initiatives promoting universal access are also creating unprecedented opportunities for persons with HIV-associated immunosuppression to be exposed to patients with infectious tuberculosis (TB) within health care facilities, with the attendant risks of acquiring TB infection and developing TB disease. Infection control measures can reduce the risk of Mycobacterium tuberculosis transmission even in settings with limited resources, on the basis of a 3-level hierarchy of controls, including administrative or work practice, environmental controls, and respiratory protection. Further research is needed to define the most efficient interventions. The importance of preventing transmission of M. tuberculosis in the era of expanding HIV care and treatment in resource-limited settings must be recognized and addressed.

Integrating tuberculosis and HIV services in rural Kenya: uptake and outcomes

“…TB infection control is of particular concern if TB patients are brought into HIV clinics with susceptible pools of individuals. 34,35 We adapted this by introducing several easily achievable measures (Table 1). Transferring the HIV care of co-infected TB patients to TB clinics is another way of alleviating this challenge; however, this was not implemented due to the limited availability of resources for TB.…”

The HIV-associated tuberculosis epidemic—when will we act?

“…Intensifi ed case fi nding promotes early start of tuberculosis treatment, which reduces HIV-related tuberculosis disease and death, and simultaneously contributes to infection control by reducing transmission of tuberculosis in communities and health facilities. 14,39 Isoniazid preventive therapy treats latent tuberculosis infection, thereby reducing progression to active disease, and simultaneously prevents new infections from becoming established. 40 Major barriers to eff ective implementation of tuberculosis screening and preventive therapy include the diffi culty of diagnosis of both tuberculosis infection and disease, and the length and toxic eff ects of available antituberculosis treatment regimens.…”

“…39 In areas of high HIV prevalence, HIV-related tuberculosis accounts for a large proportion of all admissions and outpatient consultations, resulting in intense tuberculosis transmission within congested facilities and presenting a very diffi cult challenge to infection control. 65 Data are also emerging about the crucial link between HIV and spread of MDR and XDR tuberculosis in institutional settings such as hospitals and prisons.…”

One-stop TB-HIV services evaluation in Rwanda: comparison of the 2001–2005 and 2006–2010 cohorts

“…The implementation of the services might depend on the commitment, resources and infrastructures of the HFs, and especially their infection control design. Many countries are still facing this building challenge, 7 and efforts have been deployed by the Rwandan Ministry of Health to address it. Nurses have been trained, but the high turnover of trained staff has worsened the situation.…”