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Surveillance for TB in HIV Care and Treatment Settings (CTS)

This article by Dr. Lisa J. Nelson explores the rationale and methods for conducting tuberculosis (TB) surveillance within HIV care and treatment settings, emphasizing the importance of monitoring TB cases among HIV patients. It discusses the relevance of collecting specific data elements, assessing TB suspects, and incorporating interventions like ART and IPT.

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Surveillance for TB in HIV Care and Treatment Settings (CTS)

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  1. Surveillance for TB in HIV Care and Treatment Settings (CTS) Lisa J. Nelson, MD MPH MS TB/HIV Team Leader International Research and Programs Branch Division of TB Elimination, CDC

  2. Timeline of TB/HIV Surveillance HIV infection TB diagnosed Timeline

  3. Rationale for TB Surveillance in CTS • TB is important cause of morbidity and mortality • Care and treatment programs should have measurable effect • TB may be well-suited to measure trends over time • Possibility of studying other interventions

  4. Antiretroviral Therapy (ART)

  5. Possibility of Evaluating Other Interventions • Intensified TB Case Finding (ICF) • Isoniazid Preventive Therapy (IPT) • Cotrimoxazole Preventive Therapy (CPT) • Antiretroviral therapy (ART)

  6. Considerations for TB Surveillance in CTS • Case definition of TB • What data elements to collect • Smear status • Disease status (pulmonary vs. extrapulmonary) • CD4 at TB diagnosis • Previous history of TB or IPT • TB treatment outcome

  7. TB Assessment for Patients in Chronic HIV Care Suspect TB Suspect TB: Cough > 2 weeks, persistent fever, unexplained weight loss, severe undernutrition, suspicious nodes, sweats New Sm+ or Tx plan from District: treat for TB TB suspected on prior visit Active TB Suspect TB On TB tx Send 3 sputums Refer if not producing sputum or nodes No SSx, Not on tx or prophylaxis No SSx or on prophylaxis No suspicion of TB WHO/CDS/IMAI/2004.2

  8. How/Where to Conduct? • At HIV diagnosis • Clinical settings (hospital, OPD) • Program settings (VCT, PMTCT, prior to IPT) • In HIV care and treatment settings (CTS) • Clinics providing ARV • Home-based care

  9. Methodological and Logistical Issues • Care interventions may increase TB rates • ART may cause immune reconstitution phenomena • Intensified TB case finding (vs. passive case detection) • May require complicated analysis • Need to ensure TB cases are notified to NTP • Fewer ethical issues

  10. Use of TB Surveillance Systems • Include additional variables • Source of referral • Prior use of IPT • Use of CPT, ART • Need to have referral mechanism in place

  11. Conclusions • TB surveillance in CTS more complicated • Must be considered as care and treatment programs scale up • Consensus needed on methodology and approach

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