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 Bolokadze; O Kirk; TB:HIV Study Group

doi:10.1111/hiv.13016

Healthcare delivery for HIV-positive people with tuberculosis in Europe

HIV Med. 2021 Apr;22(4):283-293. doi: 10.1111/hiv.13016. Epub 2020 Nov 20.

Authors

A K Bentzon¹, A Panteleev², V Mitsura³, E Borodulina⁴, A Skrahina⁵, E Denisova⁶, S Tetradov⁷, R Podlasin⁸, V Riekstina⁹, Z Kancauskiene¹⁰, D Paduto¹¹, A Mocroft¹², T Trofimova¹³, R Miller¹⁴, F Post¹⁵, A Grezesczuk¹⁶, J D Lundgren¹, M Inglot¹⁷, D Podlekareva¹, N Bolokadze¹⁸, O Kirk¹; TB:HIV Study Group

Collaborators

TB:HIV Study Group:
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, M Thompson, J Kozlowska, M Bura, B Knysz, A Garlicki, J Loster, D Duiculescu, A Rakhmanova, O Panteleeva, A Yakovlev, A Kozlov, A Tyukalova, Y Vlasova, T Trofimov, G Kyselyova, N Obel, J Gerstoft, G Kronborg, M C Payen, K Kabeya, C Necsoi, F Dabis, A Tsaranazy, C Cazanave, H Furrer, M Sagette, M Rickenbach, L Elzi, M Battegay, H Furrer, D Sculier, A Calmy, M Cavassini, A Bruno, E Bernasconi, M Hoffmann, P Vernazza, J Fehr, R Weber, N Vora, G Cooke, S Mullaney, E Wilkins, V George, P Collini, D Dockrell, L Campbell, R Brum, E Mabonga, P Saigal, S Kegg, J Ainsworth, A Waters, J Dhar, K Ellis, Ospedale L Spallanzani, E Girardi, A Rianda, V Galati, C Pinnetti, C Tommasi, A O San Gerardo, G Lapadula, A Di Biagio, A Parisini, S Carbonara, G Angarano, M Purgatorio, A Matteelli, A Apostoli, J M Miro, C Manzardo, C Ligero, J Gonzalez, Jose A Martinez-Martinez, F Sanchez, H Knobel, M Salvadó, J L Lopez-Colomes, X Martínez-Lacasa, E Cuchí, V Falcó, A Curran, M T Tortola, I Ocaña, R Vidal, M A Sambeat, V Pomar, P Coll, D Pozamczer, M Saumoy, F Alcaide, J Caylà, A Moreno, J P Millet, A Orcau, L Fina, A Romero, L L Roldan, J A Iribarren, M Ibarguren, S Moreno, A González, P Miralles, T Aldámiz-Echevarría, M Losso, J Toibaro, L Gambardella, J M Ramos Mejía, J Toibaro, L Moreno Macias, E Warley, S Tavella, O Garcia Messina, O Gear, H Laplume, C Marson, J Contarelia, M Michaan, P Scapellato, B Bartoletti, D Palmero, C Elias, C Cortes, B Crabtree, J L Mosqueda Gomez, J A Villanueva, L A Gonzalez Hernandez, F Badial

Affiliations

¹ CHIP (Centre of Excellence for Health, Immunity and Infections), Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
² Department of HIV/TB, TB Hospital 2, St Petersburg, Russia.
³ Gomel State Medical University, Gomel, Belarus.
⁴ Department of Phthisiology and Pulmonology, Samara State Medical University of Minzdrav of Russia, Samara, Russia.
⁵ Republican Research and Practical Clinic for Pulmonology, Minsk, Belarus.
⁶ Botkin Hospital of Infectious Disease, St Petersburg, Russia.
⁷ Dr. Victor Babes Hospital, Bucharest, Romania.
⁸ Wojewodski Szpital Zakanzy/Medical University of Warsaw, Warsaw, Poland.
⁹ Clinic of TB and Lung Diseases, Riga, Latvia.
¹⁰ Clinic for Communicable Diseases and AIDS, Vilnius, Lithuania.
¹¹ Gomel Region Clinic for Hygiene, Svetlogorsk, Belarus.
¹² Department of Infection and Population Health, University College London, London, UK.
¹³ Clinic for Prevention and Control of AIDS, Novgorod, Russia.
¹⁴ Mortimer Market Clinic, London, UK.
¹⁵ King's College Hospital, London, UK.
¹⁶ Medical University Teaching Hospital, Bialystok, Poland.
¹⁷ Wroclaw University School of Medicine, Wroclaw, Poland.
¹⁸ Infectious Diseases, AIDS and Clinical Immunology Research Clinic, Tbilisi, Georgia.

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.

Keywords: HIV; clinical management; coinfection; eastern Europe; tuberculosis; western Europe.

MeSH terms

Antitubercular Agents / therapeutic use
Delivery of Health Care
Europe / epidemiology
HIV Infections* / complications
HIV Infections* / drug therapy
Humans
Tuberculosis* / diagnosis
Tuberculosis* / drug therapy

Substances

Antitubercular Agents

Abstract

MeSH terms

Substances

Grants and funding