BACKGROUND: TB remains the largest killer among people living with HIV/AIDS (PLWHA), claiming 167000 in 2022. Urine lipoarabinomannan (TB-LAM) and tuberculosis prevention therapy (TPT) are key medical tools for screening, diagnosing and preventing TB/HIV coinfection.
TPT involves using one or more antitubercular drugs to prevent progression to active TB disease. 2020 WHO guidelines recommend TPT for PLHIV who test negative for TB and specify preferred TPT regimens: isoniazid preventive therapy (IPT) and rifamycin-based shorter regimes.
TB-LAM is the only point-of-care rapid test for diagnosing TB among PLWHA. WHO guidelines recommend TB-LAM in inpatient settings for PLWHA with TB signs/symptoms, severe illness, or CD4<200 cells/mm3. In outpatient settings, administer TB-LAM for those with TB signs, serious illness, or CD4<100 cells/mm3.
We evaluate the adoption status of TB-LAM and TPT in SSA by examining the national HIV and TB guidelines in sub-Saharan Africa (SSA), home to 22/30 high-burden TB/HIV countries (HBCs).
METHODS: To identify the adoption status of TPT and TB-LAM recommendations in sub-Saharan Africa (SSA), we reviewed the most recent national strategic plans for HIV and TB, guidelines, and other relevant national documents and updates via desktop reviews or the document repository of the HIV Policy Lab (www.hivpolicylab.org). We analyzed where national policies aligned with WHO TB-LAM and TPT for recommendations for PLWHA.
RESULTS: TB-LAM: Relevant guidelines were found for 45/48 countries. Among the 22 HBCs, at least 9 have adopted WHO TB-LAM recommendations in national guidelines. Of the remaining 23 countries in SSA not designated as HBC, only Rwanda has adopted optimal policies.
TPT: Relevant guidelines were found for 43/48 countries in SSA. 37 countries provide TPT to children living with HIV and 27 countries offer TPT for PLHIV. Further, 29 countries include only IPT while 13 include shorter regimens. For 22 HBCs in SSA, at least 7 countries have adopted rifamycin-based regimes in national guidelines.
CONCLUSIONS: Despite the proven effectiveness of TB-LAM and TPT as screening, diagnosing and prevention strategy for TB/HIV coinfection, significant policy gaps remain that should be addressed to improve TB-related outcomes among PLWHA.