Healthcare delivery for HIV-positive people with tuberculosis in Europe

A. K. Bentzon*, A. Panteleev, V. Mitsura, E. Borodulina, A. Skrahina, E. Denisova, S. Tetradov, R. Podlasin, V. Riekstina, Z. Kancauskiene, D. Paduto, A. Mocroft, T. Trofimova, R. Miller, F. Post, A. Grezesczuk, J. D. Lundgren, M. Inglot, D. Podlekareva, N. BolokadzeO. Kirk, I. Karpov, A. Vassilenko, D. Klimuk, A. Skrahin, O. Kondratenko, A. Zalutskaya, V. Bondarenko, E. Kozorez, O. Tumash, O. Suetnov, V. Iljina, T. Kummik, K. Mshvidobadze, N. Lanchava, L. Goginashvili, L. Mikiashvili, N. Bablishvili, B. Rozentale, I. Zeltina, I. Janushkevich, I. Caplinskiene, S. Caplinskas, A. Wiercinska-Drapalo, N. Obel, J. Gerstoft, G. Kronborg, M. Hoffmann, L. Campbell, A. González, the TB:HIV Study Group

*Corresponding author for this work

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Abstract

Background: In a 2013 survey, we reported distinct discrepancies in delivery of tuberculosis (TB) and HIV services in eastern Europe (EE) vs. western Europe (WE). Objectives: To verify the differences in TB and HIV services in EE vs. WE. Methods: Twenty-three sites completed a survey in 2018 (EE, 14; WE, nine; 88% response rate). Results were compared across as well as within the two regions. When possible, results were compared with the 2013 survey. Results: Delivery of healthcare was significantly less integrated in EE: provision of TB and HIV services at one site (36% in EE vs. 89% in WE; P = 0.034), and continued TB follow-up in one location (42% vs. 100%; P = 0.007). Although access to TB diagnostics, standard TB and HIV drugs was generally good, fewer sites in EE reported unlimited access to rifabutin/multi-drug-resistant TB (MDR-TB) drugs, HIV integrase inhibitors and opioid substitution therapy (OST). Compared with 2013, routine usage of GeneXpert was more common in EE in 2018 (54% vs. 92%; P = 0.073), as was access to moxifloxacin (46% vs. 91%; P = 0.033), linezolid (31% vs. 64%; P = 0.217), and bedaquiline (0% vs. 25%; P = 0.217). Integration of TB and HIV services (46% vs. 39%; P = 1.000) and provision of OST to patients with opioid dependency (54% vs. 46%; P = 0.695) remained unchanged. Conclusion: Delivery of TB and HIV healthcare, including integration of TB and HIV care and access to MDR-TB drugs, still differs between WE and EE, as well as between individual EE sites.

Original languageEnglish
JournalHIV Medicine
Volume22
Issue number4
Pages (from-to)283-293
ISSN1464-2662
DOIs
Publication statusPublished - 2021

Bibliographical note

Publisher Copyright:
© 2020 British HIV Association

Keywords

  • clinical management
  • coinfection
  • eastern Europe
  • HIV
  • tuberculosis
  • western Europe

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