TB Guard program – a cascade of care for TB prophylaxis
at Baylor Clinical Centre of Excellence (COE) in Constanta, Romania
S. Mihale 1 , E. Vasiliu 1 , A-M. Schweitzer 1 , A. Butuc 1 , V. Cindea 2
1. Baylor Black Sea Foundation, Infectious Diseases
2. Baylor Black Sea Foundation, Medical, Constanta, Romania
Background The coinfection HIV – TB is at global level the principal cause of death among people living with HIV and AIDS (PLWHA)
In 2013 Romania had the highest incidence of TB from the European area.
Constanta occupies the second place on HIV incidence after Bucharest, the capital of Romania.
WHO recommends the three I for TB/HIV coinfection:
Ѻ Ѻ Intensified case finding
Ѻ Ѻ Isoniazid Preventive Therapy (IPT)
Ѻ Ѻ Infection Control for TB
The goal of TB Guard project is to ensure timely access to IPT for those considered at high risk for TB (PLWHA with
CD4<200, HIV infected pregnant women, TB contacts, children exposed to HIV aged 0-2 years old).
Methods Who: a team of 2 health professionals (nurse and TB specialist) assisted by a receptionist
How: active case finding (directly contacting PLWHA from the high risk groups); TB symptoms screening; evaluating pa-
tients’ TB knowledge level; ITP initiation for those at risk for TB; connecting those with TB symptoms to the community
medical services for diagnosis and treatment; medical evaluations
Active case finding
Ѻ Ѻ Directly approaching patients with CD4<200, pregnant women under monitoring at the ob/gyn medical service;
TB symptoms screening
Ѻ Ѻ Every quarter for a month, a TB screening questionnaire with 4 questions is applied to all PLWHA who access the services
provided at the clinic
A TB knowledge evaluation scale: developed on 3 levels (basic, intermediary, advanced), each level with 2 components:
“knows”, “can do”.
Results In 2015 Baylor Romania COE was the only center in Romania
that actively enrolled patients on IPT
Ѻ Ѻ The program successfully initiated on IPT about 15% of the ac-
tive patients’ population
Ѻ Ѻ 53% of them received information about TB through various
methods (screening, medical evaluation, etc)
Ѻ Ѻ 34% of all COE’s patients were evaluated for TB
Ѻ Ѻ 41.31% of them were considered at high risk for TB, therefore
initiated on IPT
Ѻ Ѻ 26.19% successfully finalized the 6 months of IPT
Implementation of IPT in 2015
305
126
33
Total no. of patients
evaluated
Implementation of IPT in 2015
305
In 2015 received
IPT :
Ѻ Ѻ 49% of the eligible PLWHA with CD<200
Ѻ Ѻ 69% of the eligible HIV infected pregnant women
Ѻ Ѻ 54% of children exposed to HIV aged 0-2 years old
Conclusions
No. of patients on IPT
8
PREGNANT WOMEN
18
TB CONTACTS
HIV EXPOSED CHILDREN <= 2
YEARS OLD
29
69
PATIENTS WITH CD4<200
33
Patients with IPT
course finalized
Patients with IPT
course finalized
Situation of Patients on IPT in 2015
126
Total no. of patients
evaluated
No. of patients on IPT
126
TOTAL NO. OF PATIENTS ON IPT
0
20
40
60
80
100
120
140
The success of IPT initiation is also influenced by the patients’ level of knowledge about the risk represented by TB for the
PLWHA
PLWHA considered at highest risk (with CD4< 200) have already low adherence to HAART so the chances of refusal of
initiation of IPT, low IPT adherence/ stop IPT after initiation are high
Interventions that target both education and therapy initiation should be considered
The education efforts are hindered by lack of clear data about the duration of protection against TB of a PLWHA after a
successful IPT course
PRESENTED AT THE 21ST INTERNATIONAL AIDS CONFERENCE - DURBAN, SOUTH AFRICA