TB preventive therapy for people living with HIV: key considerations for scale-up in resource-limited settings.
TB preventive therapy for people living with HIV: key considerations for scale-up in resource-limited settings.
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DOI：
10.5588/ijtld.17.0758
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发表时间：
2018-06-01
期刊：
影响因子：
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通讯作者：
Cavanaugh JS
中科院分区：
文献类型：
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作者：
Pathmanathan I;Ahmedov S;Pevzner E;Anyalechi G;Modi S;Kirking H;Cavanaugh JS
结核病是艾滋病毒感染者死亡的主要原因。结核病预防性治疗与抗逆转录病毒治疗协同或独立发挥作用，以减少结核病发病率、死亡率和艾滋病毒感染者的发病率。然而，尽管TPT是成人和儿童艾滋病毒护理的一个关键和具有成本效益的组成部分，并且十多年来一直被强烈推荐为国际护理标准，但它仍然没有得到充分利用。如果我们要结束全球结核病流行，我们必须解决结核病感染的重要储存库，特别是在那些如艾滋病毒感染者中，这些人发展为结核病的风险最高。为了做到这一点，我们必须正视一种普遍存在的看法，即在资源有限的情况下，扩大TPT的障碍是不可逾越的。在本文中，我们回顾了现有的证据，以解决TPT扩大规模的几个常见障碍。这些问题包括需要结核菌素皮试、可靠排除结核病的诊断能力有限、担心产生耐药性、患者对治疗的依从性欠佳、无法预防和监测不良事件、TPT方案和持续时间的“一刀切”选择以及儿童、青少年和孕妇使用TPT的不确定性。我们还讨论了在艾滋病毒感染者差异化护理时代的TPT交付，如何最好地解决药物采购和供应链管理的高级规划，以及如何为TPT规模扩大成功创造有利环境。
Tuberculosis (TB) is the leading cause of death for persons living with HIV (PLHIV). TB preventive therapy (TPT) works synergistically with, and independently of, antiretroviral therapy (ART) to reduce TB morbidity, mortality and incidence among PLHIV. However, although TPT is a crucial and cost-effective component of HIV care for adults and children, and has been strongly recommended as an international standard of care for over a decade, it has remained highly underutilized. If we are to end the global TB epidemic, we must address the significant reservoir of TB infection, especially in those, such as PLHIV, with highest risk of progression to TB disease. In order to do so, we must confront the pervasive perception that barriers to TPT scale-up are insurmountable in resource-limited settings. In this article, we review available evidence to address several commonly stated obstacles to TPT scale-up. These include the need for tuberculin skin testing, limited diagnostic capacity to reliably exclude TB disease, concerns about creating drug resistance, suboptimal patient adherence to therapy, inability to prevent and monitor for adverse events, a “one size fits all” option for TPT regimen and duration, and uncertainty about TPT use in children, adolescents, and pregnant women. We also discuss TPT delivery in the era of differentiated care for PLHIV, how to best tackle advanced planning for drug procurement and supply chain management, and how to create an enabling environment for TPT scale-up success.