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Open Access Leveraging differentiated HIV service delivery to expand tuberculosis preventive treatment: a call to action

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Tuberculosis (TB) is the leading cause of death among people living with human immunodeficiency virus (PLHIV), and sub-Saharan Africa has a particularly heavy burden of HIV-associated TB. Although effective TB preventive treatment (TPT) has been available for decades and shorter regimens are newly available in some settings, TPT coverage among PLHIV is suboptimal, leading to preventable illness and death. In 2018, the United Nations High-Level Meeting on Ending Tuberculosis called for ambitious new targets for TPT coverage among PLHIV and many countries in sub-Saharan Africa have redoubled their efforts to take TPT to scale. Importantly, however, this push to expand TPT among PLHIV is taking place in the context of a changing HIV treatment delivery landscape. Countries in sub-Saharan Africa are at the forefront of innovative changes in HIV program design, including a shift towards less-intensive differentiated service delivery (DSD) models for stable patients doing well on antiretroviral therapy. Understanding the opportunities and challenges that DSD presents for TB diagnosis, prevention and linkage to care among PLHIV will be critical to success.
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Keywords: TB preventive therapy; differentiated service delivery; human immunodeficiency virus; tuberculosis

Document Type: Research Article

Affiliations: 1: ICAP at Columbia University, New York, NY, Departments of Medicine & Epidemiology, Columbia University Mailman School of Public Health, New York, NY 2: The Bill & Melinda Gates Foundation, Seattle, WA, USA 3: The International AIDS Society, Geneva, Switzerland 4: ICAP at Columbia University, Mbabane, Eswatini 5: World Health Organization, Geneva, Switzerland 6: US Centers for Disease Control and Prevention, Atlanta, GA, USA

Publication date: February 1, 2020

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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