Implementation of Tuberculosis Intensive Case Finding, Isoniazid Preventive Therapy, and Infection Control ("Three I's") and HIV-Tuberculosis Service Integration in Lower Income Countries.

Journal Article (Journal Article)

SETTING: World Health Organization advocates for integration of HIV-tuberculosis (TB) services and recommends intensive case finding (ICF), isoniazid preventive therapy (IPT), and infection control ("Three I's") for TB prevention and control among persons living with HIV. OBJECTIVE: To assess the implementation of the "Three I's" of TB-control at HIV treatment sites in lower income countries. DESIGN: Survey conducted between March-July, 2012 at 47 sites in 26 countries: 6 (13%) Asia Pacific, 7 (15%), Caribbean, Central and South America, 5 (10%) Central Africa, 8 (17%) East Africa, 14 (30%) Southern Africa, and 7 (15%) West Africa. RESULTS: ICF using symptom-based screening was performed at 38% of sites; 45% of sites used symptom-screening plus additional diagnostics. IPT at enrollment or ART initiation was implemented in only 17% of sites, with 9% of sites providing IPT to tuberculin-skin-test positive patients. Infection control measures varied: 62% of sites separated smear-positive patients, and healthcare workers used masks at 57% of sites. Only 12 (26%) sites integrated HIV-TB services. Integration was not associated with implementation of TB prevention measures except for IPT provision at enrollment (42% integrated vs. 9% non-integrated; p = 0.03). CONCLUSIONS: Implementation of TB screening, IPT provision, and infection control measures was low and variable across regional HIV treatment sites, regardless of integration status.

Full Text

Duke Authors

Cited Authors

  • Charles, MK; Lindegren, ML; Wester, CW; Blevins, M; Sterling, TR; Dung, NT; Dusingize, JC; Avit-Edi, D; Durier, N; Castelnuovo, B; Nakigozi, G; Cortes, CP; Ballif, M; Fenner, L; International epidemiology Databases to Evaluate AIDS (IeDEA) Collaboration,

Published Date

  • 2016

Published In

Volume / Issue

  • 11 / 4

Start / End Page

  • e0153243 -

PubMed ID

  • 27073928

Pubmed Central ID

  • PMC4830552

Electronic International Standard Serial Number (EISSN)

  • 1932-6203

Digital Object Identifier (DOI)

  • 10.1371/journal.pone.0153243


  • eng

Conference Location

  • United States