Leveraging differentiated HIV service delivery to expand tuberculosis preventive treatment: a call to action

• Published in: The international journal of tuberculosis and lung disease Vol. 24; no. 2; pp. 165 - 169
• Main Authors: Rabkin, M., Howard, A. A., Ehrenkranz, P., Fernandez, L. G., Preko, P., Singh, V., Tomlinson, H. L., El-Sadr, W. M.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01-02-2020; International Union against Tuberculosis and Lung Disease (IUATLD)
• Subjects: Africa South of the Sahara - epidemiology; Antibiotic Prophylaxis; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antitubercular Agents - therapeutic use; Differentiated Service Delivery; HIV; HIV Infections - diagnosis; HIV Infections - drug therapy; Human Immunodeficiency Virus; Humans; Tb Preventive Therapy; Tuberculosis; Tuberculosis - drug therapy; Tuberculosis - prevention & control; Viruses; Africa South of the Sahara; Africa
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.19.0595

Tuberculosis (TB) is the leading cause of death among people living with human immunodeficiency virus (PLHIV), and sub-Saharan Africa has a particularly heavy burden of HIV-associated TB. Although effective TB preventive treatment (TPT) has been available for decades and shorter regimens
are newly available in some settings, TPT coverage among PLHIV is suboptimal, leading to preventable illness and death. In 2018, the United Nations High-Level Meeting on Ending Tuberculosis called for ambitious new targets for TPT coverage among PLHIV and many countries in sub-Saharan Africa
have redoubled their efforts to take TPT to scale. Importantly, however, this push to expand TPT among PLHIV is taking place in the context of a changing HIV treatment delivery landscape. Countries in sub-Saharan Africa are at the forefront of innovative changes in HIV program design, including
a shift towards less-intensive differentiated service delivery (DSD) models for stable patients doing well on antiretroviral therapy. Understanding the opportunities and challenges that DSD presents for TB diagnosis, prevention and linkage to care among PLHIV will be critical to success.