{
  "abstract": "Introduction Towards the ‘End TB Strategy’ targets, the WHO recommends the provision of tuberculosis (TB) preventive therapy (TPT) for high-risk groups including people living with HIV (PLWH). 3 years after the release of the updated 2020 WHO guidelines, we investigated the implementation of TPT services at HIV clinics in low-income and middle-income countries (LMICs), focusing on TB screening, populations eligible for TPT and available TPT regimens.Methods In 2023, we surveyed HIV care clinics in the International Epidemiology Databases to Evaluate AIDS consortium in Africa, the Asia-Pacific and Latin America and the Caribbean. We used descriptive statistics to summarise TPT implementation according to WHO guidelines and multivariable logistic regression models to estimate associations with clinic characteristics.Results Of 172 HIV clinics included, 142 (83%) were in Africa, 22 (13%) in the Asia-Pacific and 8 (5%) in Latin America; 108 (63%) were located in urban areas. After ruling out active TB, TPT was reportedly offered to PLWH (122 clinics, 71%), household contacts of individuals with active TB (120 clinics, 70%) and other high-risk populations. TPT for PLWH was more frequently available in clinics in lower-income and low-middle-income countries, in high TB burden countries, and in district hospitals compared with other facility types. Clinics reported use of isoniazid-based (160 clinics, 93%) and shorter rifamycin-based (129 clinics, 75%) TPT regimens. Reported barriers to TPT initiation included patient refusal at 71 (41%) and drug shortages at 67 (39%) clinics.Conclusions TPT was available at most HIV care clinics in LMICs but further efforts are needed to reinforce WHO recommendations and ensure that TPT is consistently accessible to people at higher risk of developing active TB, especially PLWH.",
  "authors": [
    {
      "affiliations": [
        "Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland",
        "Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland",
        "University of Basel, Basel, Switzerland"
      ],
      "name": "Remo Schmutz"
    },
    {
      "affiliations": [
        "Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland",
        "Department of Public Health, University of Copenhagen, Copenhagen, Denmark"
      ],
      "name": "Nicolas Banholzer"
    },
    {
      "affiliations": [
        "Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "Kate Shearer"
    },
    {
      "affiliations": [
        "Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"
      ],
      "name": "Jonathan E Golub"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Faculty of Medicine, Universidad de Chile & Fundación Arriarán, Santiago de Chile, Chile"
      ],
      "name": "Claudia P. Cortes"
    },
    {
      "affiliations": [
        "CePReF-Aconda, Abidjan, Côte d’Ivoire"
      ],
      "name": "Eugène Messou"
    },
    {
      "affiliations": [
        "Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo"
      ],
      "name": "Nana Mbonze"
    },
    {
      "affiliations": [
        "Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Kampala, Uganda"
      ],
      "name": "Joseph Musaazi"
    },
    {
      "affiliations": [
        "Centre for Infectious Disease Research in Zambia, Lusaka, Zambia"
      ],
      "name": "Guy Muula"
    },
    {
      "affiliations": [
        "Faculty of Medicine, Hasan Sadikin General Hospital, Bandung, Indonesia"
      ],
      "name": "Anggraini Alam"
    },
    {
      "affiliations": [
        "Instituto Hondureño de Seguridad Social and Hospital Escuela Universitario, Tegucigalpa, Honduras"
      ],
      "name": "Diana Varela"
    },
    {
      "affiliations": [
        "CHU Bobo Dioulasso, Bobo Dioulasso, Burkina Faso"
      ],
      "name": "Armel Poda"
    },
    {
      "affiliations": [
        "Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA"
      ],
      "name": "Ellen Brazier"
    },
    {
      "affiliations": [
        "Department of Medicine, Moi University, AMPATH Program / Moi Teaching and Referral Hospital, Eldoret, Kenya"
      ],
      "name": "Lameck Diero"
    },
    {
      "affiliations": [
        "SolidarMed, SolidarMed, Masvingo, Zimbabwe"
      ],
      "name": "Cordelia Kunzekwenyika"
    },
    {
      "affiliations": [
        "The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Awachana Jiamsakul"
    },
    {
      "affiliations": [
        "Les Centres GHESKIO, Port-au-Prince, Haiti",
        "Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, NY, USA"
      ],
      "name": "Vanessa Rouzier"
    },
    {
      "affiliations": [
        "Centre de Traitement Ambulatoire, Centre Hospitalier Universitaire HKM, Cotonou, Benin"
      ],
      "name": "Marcel Zannou"
    },
    {
      "affiliations": [
        "Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA"
      ],
      "name": "Marcel Yotebieng"
    },
    {
      "affiliations": [
        "The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA"
      ],
      "name": "Leslie A. Enane"
    },
    {
      "affiliations": [
        "Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland",
        "Africa Health Research Institute, Durban, South Africa"
      ],
      "name": "Dickman Gareta"
    },
    {
      "affiliations": [
        "Universidade Federal de Minas Gerais, Belo Horizonte, Brazil"
      ],
      "name": "Jorge Pinto"
    },
    {
      "affiliations": [
        "PAC-CI program, Abidjan, Côte d’Ivoire"
      ],
      "name": "Eric Komena"
    },
    {
      "affiliations": [
        "Kalembelembe Pediatric Hospital, Kinshasa, Democratic Republic of Congo"
      ],
      "name": "Patricia Lelo"
    },
    {
      "affiliations": [
        "Mbarara University of Science and Technology, Mbarara, Uganda"
      ],
      "name": "Winnie Muyindike"
    },
    {
      "affiliations": [
        "School of Public Health, University of Cape Town, Cape Town, South Africa"
      ],
      "name": "Jonathan Euvrard"
    },
    {
      "affiliations": [
        "Department of Biomedical Informatics, School of Medicine, Vanderbilt University, Nashville, Tennessee, USA"
      ],
      "name": "Stephany N. Duda"
    },
    {
      "affiliations": [
        "Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, Georgia, USA"
      ],
      "name": "N. Sarita Shah"
    },
    {
      "affiliations": [
        "Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"
      ],
      "name": "Samyra R. Cox"
    },
    {
      "affiliations": [
        "Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland",
        "Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland"
      ],
      "name": "Marie Ballif"
    },
    {
      "affiliations": [
        "Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland"
      ],
      "name": "Lukas Fenner"
    },
    {
      "affiliations": [],
      "name": "The IeDEA global consortium"
    }
  ],
  "title": "The implementation of tuberculosis preventive therapy in HIV care clinics in Africa, Asia and Latin America: a multiregional site survey",
  "uid": "35bd59a8-e14b-590d-8cd6-1b05e64b81c9"
}