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Implementation practices of tuberculosis preventive therapy for children and HIV-positive adults University of Antwerp

Eva Van Ginderdeuren
Background: Tuberculosis preventive therapy (TPT) reduces the risk of progression from infection with Mycobacterium tuberculosis to active tuberculosis disease (TB), in particular for high risk groups such as people living with HIV (PLHIV) and children in close contact with a person affected by TB. To reach global TB elimination, TPT needs to be scaled-up. Yet, global TPT uptake is low and once on TPT, few people succeed to complete their TPT ...

High conversion of tuberculin skin tests during the first year of antiretroviral treatment among South African adults in primary care University of Antwerp

Eva Van Ginderdeuren, Jean Bassett, Colleen F. Hanrahan, Lillian Mutunga, Annelies Van Rie
Objectives: Anergy reduces the sensitivity of the tuberculin skin test (TST) to detect Mycobacterium tuberculosis infection in people living with HIV. Antiretroviral treatment (ART) can reverse TST anergy, but data is scarce. Methods: To estimate TST conversion rates and factors associated with TST conversion, TST was placed at ART initiation, and 6 and 12 months thereafter (if TST negative at prior assessment). Results: Of 328 ART-eligible ...

Association between monocyte-to-lymphocyte ratio and tuberculin skin test positivity in HIV-positive adults University of Antwerp

Eva Van Ginderdeuren, Jean Bassett, Colleen F. Hanrahan, Annelies Van Rie
Background The tuberculin skin test (TST) identifies individuals at high risk of developing tuberculosis (TB) but poses many challenges. The blood monocyte-to-lymphocyte ratio (MLR) could be an alternative, as extremes in MLR have been associated with increased risk of TB disease. Methods At a primary care clinic in Johannesburg, a differential white blood cell count and TST was performed in adults starting antiretroviral treatment (ART) without ...

Gaps in the tuberculosis preventive therapy care cascade in children in contact with TB University of Antwerp

Eva Van Ginderdeuren, J. Bassett, C.F. Hanrahan, L. Mutunga, Annelies Van Rie
Background: Young children (<5 years) and children living with HIV in contact with an adult with tuberculosis (TB) should receive TB preventive therapy (TPT), but uptake is low. Aim: To determine gaps in the uptake of and adherence to TPT in child TB contacts under routine primary care clinic conditions. Methods: A cohort of child TB contacts (age <5 years or living with HIV <15 years) was followed at a primary care clinic in ...

Novel health system strategies for tuberculin skin testing at primary care clinics: performance assessment and health economic evaluation University of Antwerp

Eva Van Ginderdeuren, Jean Bassett, Colleen F. Hanrahan, Lillian Mutunga, Annelies Van Rie
Background Tuberculin skin test (TST) for guiding initiation of tuberculosis preventive therapy poses major challenges in high tuberculosis burden settings. Methods At a primary care clinic in Johannesburg, South Africa, 278 HIV-positive adults self-read their TST by reporting if they felt a bump (any induration) at the TST placement site. TST reading (in mm) was fast-tracked to reduce patient wait time and task-shifted to delegate tasks to ...

Health system barriers to implementation of TB preventive strategies in South African primary care facilities University of Antwerp

Eva Van Ginderdeuren, Jean Bassett, Colleen Hanrahan, Lillian Mutunga, Annelies Van Rie
Background Isoniazid preventive therapy (IPT) is a key component of TB/HIV control, but few countries achieve high IPT coverage. Methods Using a behavioural COM-B design approach, the intervention consisted of a training on IPT guidelines and tuberculin skin testing (TST), identification of the optimal IPT implementation strategy by the health care workers (HCWs) of 3 primary care clinics, and a 2-month mentoring period. Using routine register ...