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Contextualizing and optimizing novel strategies to improve the latent TB continuum of care: Insights from people living with HIV and health care providers in Brazil

Tuberculosis (TB) causes 1 in 3 deaths among people living with HIV (PLHIV). Diagnosing and treating latent tuberculosis infection (LTBI) is critical to reducing TB incidence and mortality. Blood-based screening tests (e.g., QuantiFERON-TB Gold Plus (QFT+)) and shorter-course TB preventive therapy (...

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Autores principales: Salles, Isadora, Travassos, Paula, Spener-Gomes, Renata, Loch, Ana Paula, Saraceni, Valeria, Lauria, Lilian, Cavalcante, Solange, Garcia de Oliveira, Jamile, Brito de Souza, Alexandra, Guimarães Costa, Allyson, Sakabe, Sumire, Schiavon Nogueira, Roberta, Chaisson, Lelia H., Cohn, Silvia, Jamal, Leda Fatima, Valdez Ramalho Madruga, Jose, Cordeiro-Santos, Marcelo, Castro, Barbara, Portella Ferreira, Danielle, Hoffmann, Christopher J., Golub, Jonathan E., Durovni, Betina, Kerrigan, Deanna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021802/
https://www.ncbi.nlm.nih.gov/pubmed/36962892
http://dx.doi.org/10.1371/journal.pgph.0001251
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author Salles, Isadora
Travassos, Paula
Spener-Gomes, Renata
Loch, Ana Paula
Saraceni, Valeria
Lauria, Lilian
Cavalcante, Solange
Garcia de Oliveira, Jamile
Brito de Souza, Alexandra
Guimarães Costa, Allyson
Sakabe, Sumire
Schiavon Nogueira, Roberta
Chaisson, Lelia H.
Cohn, Silvia
Jamal, Leda Fatima
Valdez Ramalho Madruga, Jose
Cordeiro-Santos, Marcelo
Castro, Barbara
Portella Ferreira, Danielle
Hoffmann, Christopher J.
Golub, Jonathan E.
Durovni, Betina
Kerrigan, Deanna
author_facet Salles, Isadora
Travassos, Paula
Spener-Gomes, Renata
Loch, Ana Paula
Saraceni, Valeria
Lauria, Lilian
Cavalcante, Solange
Garcia de Oliveira, Jamile
Brito de Souza, Alexandra
Guimarães Costa, Allyson
Sakabe, Sumire
Schiavon Nogueira, Roberta
Chaisson, Lelia H.
Cohn, Silvia
Jamal, Leda Fatima
Valdez Ramalho Madruga, Jose
Cordeiro-Santos, Marcelo
Castro, Barbara
Portella Ferreira, Danielle
Hoffmann, Christopher J.
Golub, Jonathan E.
Durovni, Betina
Kerrigan, Deanna
author_sort Salles, Isadora
collection PubMed
description Tuberculosis (TB) causes 1 in 3 deaths among people living with HIV (PLHIV). Diagnosing and treating latent tuberculosis infection (LTBI) is critical to reducing TB incidence and mortality. Blood-based screening tests (e.g., QuantiFERON-TB Gold Plus (QFT+)) and shorter-course TB preventive therapy (TPT) regimens such as 3HP (3 months weekly isoniazid-rifapentine) hold significant promise to improve TB outcomes. We qualitatively explored barriers and solutions to optimizing QFT+ and 3HP among PLHIV in three cities in Brazil. We conducted 110 in-depth interviews with PLHIV, health care providers (HCP) and key informants (KI). Content analysis was conducted including the use of case summaries and comparison of themes across populations and contexts. LTBI screening and treatment practices were dependent on HCP’s perceptions of whether they were critical to improving TB outcomes. Many HCP lacked a strong understanding of LTBI and perceived the current TPT regimen as complicated. HCP reported that LTBI screening and treatment were constrained by clinic staffing challenges. While PLHIV generally expressed willingness to consider any test or treatment that doctors recommended, they indicated HCP rarely discussed LTBI and TPT. TB testing and treatment requests were constrained by structural factors including financial and food insecurity, difficulties leaving work for appointments, stigma and family responsibilities. QFT+ and 3HP were viewed by all participants as tools that could significantly improve the LTBI cascade by avoiding complexities of TB skin tests and longer LTBI treatment courses. QFT+ and 3HP were perceived to have challenges, including the potential to increase workload on over-burdened health systems if not implemented alongside improved supply chains, staffing, and training, and follow-up initiatives. Multi-level interventions that increase understanding of the importance of LTBI and TPT among HCP, improve patient-provider communication, and streamline clinic-level operations related to QFT+ and 3HP are needed to optimize their impact among PLHIV and reduce TB mortality.
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spelling pubmed-100218022023-03-17 Contextualizing and optimizing novel strategies to improve the latent TB continuum of care: Insights from people living with HIV and health care providers in Brazil Salles, Isadora Travassos, Paula Spener-Gomes, Renata Loch, Ana Paula Saraceni, Valeria Lauria, Lilian Cavalcante, Solange Garcia de Oliveira, Jamile Brito de Souza, Alexandra Guimarães Costa, Allyson Sakabe, Sumire Schiavon Nogueira, Roberta Chaisson, Lelia H. Cohn, Silvia Jamal, Leda Fatima Valdez Ramalho Madruga, Jose Cordeiro-Santos, Marcelo Castro, Barbara Portella Ferreira, Danielle Hoffmann, Christopher J. Golub, Jonathan E. Durovni, Betina Kerrigan, Deanna PLOS Glob Public Health Research Article Tuberculosis (TB) causes 1 in 3 deaths among people living with HIV (PLHIV). Diagnosing and treating latent tuberculosis infection (LTBI) is critical to reducing TB incidence and mortality. Blood-based screening tests (e.g., QuantiFERON-TB Gold Plus (QFT+)) and shorter-course TB preventive therapy (TPT) regimens such as 3HP (3 months weekly isoniazid-rifapentine) hold significant promise to improve TB outcomes. We qualitatively explored barriers and solutions to optimizing QFT+ and 3HP among PLHIV in three cities in Brazil. We conducted 110 in-depth interviews with PLHIV, health care providers (HCP) and key informants (KI). Content analysis was conducted including the use of case summaries and comparison of themes across populations and contexts. LTBI screening and treatment practices were dependent on HCP’s perceptions of whether they were critical to improving TB outcomes. Many HCP lacked a strong understanding of LTBI and perceived the current TPT regimen as complicated. HCP reported that LTBI screening and treatment were constrained by clinic staffing challenges. While PLHIV generally expressed willingness to consider any test or treatment that doctors recommended, they indicated HCP rarely discussed LTBI and TPT. TB testing and treatment requests were constrained by structural factors including financial and food insecurity, difficulties leaving work for appointments, stigma and family responsibilities. QFT+ and 3HP were viewed by all participants as tools that could significantly improve the LTBI cascade by avoiding complexities of TB skin tests and longer LTBI treatment courses. QFT+ and 3HP were perceived to have challenges, including the potential to increase workload on over-burdened health systems if not implemented alongside improved supply chains, staffing, and training, and follow-up initiatives. Multi-level interventions that increase understanding of the importance of LTBI and TPT among HCP, improve patient-provider communication, and streamline clinic-level operations related to QFT+ and 3HP are needed to optimize their impact among PLHIV and reduce TB mortality. Public Library of Science 2023-01-04 /pmc/articles/PMC10021802/ /pubmed/36962892 http://dx.doi.org/10.1371/journal.pgph.0001251 Text en © 2023 Salles et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Salles, Isadora
Travassos, Paula
Spener-Gomes, Renata
Loch, Ana Paula
Saraceni, Valeria
Lauria, Lilian
Cavalcante, Solange
Garcia de Oliveira, Jamile
Brito de Souza, Alexandra
Guimarães Costa, Allyson
Sakabe, Sumire
Schiavon Nogueira, Roberta
Chaisson, Lelia H.
Cohn, Silvia
Jamal, Leda Fatima
Valdez Ramalho Madruga, Jose
Cordeiro-Santos, Marcelo
Castro, Barbara
Portella Ferreira, Danielle
Hoffmann, Christopher J.
Golub, Jonathan E.
Durovni, Betina
Kerrigan, Deanna
Contextualizing and optimizing novel strategies to improve the latent TB continuum of care: Insights from people living with HIV and health care providers in Brazil
title Contextualizing and optimizing novel strategies to improve the latent TB continuum of care: Insights from people living with HIV and health care providers in Brazil
title_full Contextualizing and optimizing novel strategies to improve the latent TB continuum of care: Insights from people living with HIV and health care providers in Brazil
title_fullStr Contextualizing and optimizing novel strategies to improve the latent TB continuum of care: Insights from people living with HIV and health care providers in Brazil
title_full_unstemmed Contextualizing and optimizing novel strategies to improve the latent TB continuum of care: Insights from people living with HIV and health care providers in Brazil
title_short Contextualizing and optimizing novel strategies to improve the latent TB continuum of care: Insights from people living with HIV and health care providers in Brazil
title_sort contextualizing and optimizing novel strategies to improve the latent tb continuum of care: insights from people living with hiv and health care providers in brazil
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021802/
https://www.ncbi.nlm.nih.gov/pubmed/36962892
http://dx.doi.org/10.1371/journal.pgph.0001251
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