Table 1. Implementation of the “Three I’s”* and integration of HIV-TB services in 47 HIV care and treatment facilities treating adults in lower-income countries within the IeDEA collaboration, overall and by IeDEA region.
| Asia/ Pacific | CCASAnet | Central Africa | East Africa | Southern Africa | West Africa | TOTAL | |
|---|---|---|---|---|---|---|---|
| (n = 6) | (n = 7) | (n = 5) | (n = 8) | (n = 14) | (n = 7) | (n = 47) | |
| Intensified case finding (ICF) | |||||||
| TB screening at enrollment into HIV care, n (%) | |||||||
| Symptom screening | 1 (17%) | 0 (0%) | 2 (40%) | 4 (50%) | 7 (50%) | 4 (57%) | 18 (38%) |
| Symptom screening plus additional diagnostics | 4 (67%) | 5 (71%) | 0 (0%) | 3 (38%) | 7 (50%) | 2 (29%) | 21 (45%) |
| Clinical suspicion | 1 (17%) | 2 (29%) | 3 (60%) | 1 (12%) | 0 (0%) | 1 (14%) | 8 (17%) |
| Screening algorithm during follow-up include the following symptoms and/or diagnostic tests, n (%) | |||||||
| Four-symptom screening† | 2 (33%) | 1 (14%) | 3 (60%) | 6 (75%) | 10 (71%) | 4 (57%) | 26 (55%) |
| Cough (any duration) | 3 (50%) | 1 (14%) | 3 (60%) | 6 (75%) | 10 (71%) | 4 (57%) | 27 (57%) |
| Fever (any duration) | 3 (50%) | 2 (29%) | 3 (60%) | 7 (88%) | 10 (71%) | 5 (71%) | 30 (64%) |
| Night sweats | 2 (33%) | 2 (29%) | 3 (60%) | 7 (88%) | 10 (71%) | 6 (86%) | 30 (64%) |
| Weight loss | 3 (50%) | 2 (29%) | 3 (60%) | 7 (88%) | 10 (71%) | 6 (86%) | 31 (66%) |
| Contact history with a TB case in family | 3 (50%) | 2 (29%) | 3 (60%) | 4 (50%) | 7 (50%) | 6 (86%) | 25 (53%) |
| Sputum AFB smear | 3 (50%) | 2 (29%) | 2 (40%) | 3 (38%) | 5 (36%) | 4 (57%) | 19 (40%) |
| Induced sputum | 1 (17%) | 1 (14%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 2 (4%) |
| Gastric lavage | 0 (0%) | 1 (14%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 1 (2%) |
| Biopsy | 2 (33%) | 2 (29%) | 1 (20%) | 2 (25%) | 1 (7%) | 0 (0%) | 8 (17%) |
| Chest radiography | 3 (50%) | 2 (29%) | 2 (40%) | 4 (50%) | 5 (36%) | 4 (57%) | 20 (43%) |
| TB culture | 1 (17%) | 0 (0%) | 1 (20%) | 0 (0%) | 1 (7%) | 1 (14%) | 4 (9%) |
| Other | 0 (0%) | 0 (0%) | 0 (0%) | 1 (12%) | 1 (7%) | 1 (14%) | 3 (6%) |
| Specific intensified case finding program, n (%) | 2 (33%) | 2 (29%) | 3 (60%) | 6 (75%) | 7 (50%) | 3 (43%) | 23 (49%) |
| Household intervention with contact tracing, n (%) | 0 (0%) | 1 (14%) | 1 (20%) | 3 (38%) | 6 (43%) | 1 (14%) | 12 (26%) |
| Isoniazid preventive therapy (IPT) | |||||||
| IPT for all adults (where active TB ruled out) at enrollment or time of ART start, n (%) | 1 (17%) | 2 (29%) | 0 (0%) | 1 (12%) | 3 (21%) | 1 (14%) | 8 (17%) |
| Only if TST-positive, n (%) | 1 (17%) | 3 (43%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 4 (9%) |
| Duration of IPT, n (%)‡ | |||||||
| 6 months | 1 (17%) | 0 (0%) | 0 (0%) | 0 (0%) | 3 (21%) | 1 (14%) | 5 (11%) |
| 9–12 months | 1 (17%) | 4 (57%) | 0 (0%) | 1 (12%) | 0 (0%) | 0 (0%) | 6 (13%) |
| Lifetime | 0 (0%) | 1 (14%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 1 (2%) |
| None | 4 (67%) | 2 (29%) | 5 (100%) | 7 (88%) | 10 (71%) | 6 (86%) | 34 (72%) |
| Infection control measures | |||||||
| Separation of sputum smear-positive TB patients and HIV-positive patients, n (%) | 5 (83%) | 4 (57%) | 3 (60%) | 5 (62%) | 9 (64%) | 3 (43%) | 29 (62%) |
| Separate waiting rooms and emergency wards for "coughing" patients, n (%) | 2 (33%) | 2 (29%) | 1 (20%) | 4 (50%) | 4 (29%) | 1 (14%) | 14 (30%) |
| Natural air exchange by dedicated windows, n (%) | |||||||
| Optimized natural ventilation | 3 (50%) | 3 (43%) | 2 (40%) | 4 (50%) | 8 (57%) | 1 (14%) | 21 (45%) |
| Natural ventilation, but not optimized | 1 (17%) | 4 (57%) | 3 (60%) | 4 (50%) | 6 (43%) | 6 (86%) | 24 (51%) |
| No natural ventilation | 2 (33%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 2 (4%) |
| Operated and maintained ventilators, n (%) | 3 (50%) | 5 (71%) | 2 (40%) | 1 (12%) | 4 (29%) | 2 (29%) | 17 (36%) |
| TB screening for medical staff working with TB patients, n (%) | 5 (83%) | 5 (71%) | 0 (0%) | 3 (38%) | 3 (21%) | 1 (14%) | 17 (36%) |
| Staff wear masks in close contact to TB patients, n (%) | 5 (83%) | 6 (86%) | 2 (40%) | 3 (38%) | 7 (50%) | 4 (57%) | 27 (57%) |
| Staff offered no specified TB protection, n (%) | 1 (17%) | 1 (14%) | 3 (60%) | 1 (12%) | 7 (50%) | 3 (43%) | 16 (34%) |
| Turn-around time for TB diagnosis, median days (IQR)§ | |||||||
| Smear-positive patients | 7 (5–7) | 7 (2–7) | 4 (4–7) | 2 (1–2) | 3 (2–5) | 5 (4–7) | 4 (2–7) |
| Smear-negative patients | 6 (2–17) | 14 (5–18) | 14 (14–15) | 5 (2–6) | 7 (3–14) | 15 (10–15) | 7 (4–14) |
| TB services | |||||||
| TB skin test available on site, n (%) | 5 (83%) | 6 (86%) | 2 (40%) | 1 (12%) | 4 (29%) | 3 (43%) | 21 (45%) |
| TB clinic location, n (%) | |||||||
| Same facility or same day | 1 (17%) | 4 (57%) | 2 (40%) | 4 (50%) | 7 (50%) | 3 (43%) | 21 (45%) |
| Cross referral between HIV-TB service points | 4 (67%) | 2 (29%) | 1 (20%) | 3 (38%) | 5 (36%) | 3 (43%) | 18 (38%) |
| Provision of HIV-TB services under same roof | 1 (17%) | 1 (14%) | 1 (20%) | 1 (12%) | 2 (14%) | 1 (14%) | 7 (15%) |
| None of these models | 0 (0%) | 0 (0%) | 1 (20%) | 0 (0%) | 0 (0%) | 0 (0%) | 1 (2%) |
| Availability of a specialized clinic/ward on site with dedicated staff for TB patients, n (%) | |||||||
| Yes, on site | 3 (50%) | 6 (86%) | 4 (80%) | 6 (75%) | 7 (50%) | 2 (29%) | 28 (60%) |
| No, but available off site (referral) | 2 (33%) | 1 (14%) | 0 (0%) | 1 (12%) | 2 (14%) | 4 (57%) | 10 (21%) |
| Not available | 1 (17%) | 0 (0%) | 1 (20%) | 1 (12%) | 5 (36%) | 1 (14%) | 9 (19%) |
| ART provision, n (%) | |||||||
| All HIV-infected patients | 4 (67%) | 6 (86%) | 3 (60%) | 6 (75%) | 10 (71%) | 5 (71%) | 34 (72%) |
| <200 CD4+ cell count | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 1 (14%) | 1 (2%) |
| <350 CD4+ cell count | 2 (33%) | 1 (14%) | 2 (40%) | 2 (25%) | 4 (29%) | 1 (14%) | 12 (26%) |
| Integration of HIV-TB services, n (%)‖ | |||||||
| Integrated | 0 (0%) | 3 (43%) | 0 (0%) | 4 (50%) | 4 (29%) | 1 (14%) | 12 (26%) |
| Not integrated | 6 (100%) | 4 (57%) | 5 (100%) | 4 (50%) | 10 (71%) | 6 (86%) | 35 (74%) |
*“Three I’s” defined as (1) intensified case finding, (2) IPT, (3) infection control
†Four symptom screening includes: cough, fever, night sweat, and weight loss
‡One site in Southern Africa reported unspecified “other” conditions for and duration of IPT use
§Continuous variables are reported as median number of days (interquartile range)
‖Integration clinics met the following criteria: (1) HIV patients screened for TB at enrollment using at least symptom screening; (2) TB clinic was located in the same facility/same day or under the same roof; and (3) facilities had specialized clinic/ward on site with dedicated staff for TB patients
CCASAnet = Caribbean, Central and South America; TB = tuberculosis; ART = combination antiretroviral therapy; TST = tuberculin skin testing; IQR = interquartile range