Healthcare delivery for HIV-positive people with tuberculosis in Europe

Bentzon, A. K.; Panteleev, A.; Mitsura, V.; Borodulina, E.; Skrahina, A.; Denisova, E.; Tetradov, S.; Podlasin, R.; Riekstina, V.; Kancauskiene, Z.; Paduto, D.; Mocroft, A.; Trofimova, T.; Miller, R.; Post, F.; Grezesczuk, A.; Lundgren, J. D.; Inglot, M.; Podlekareva, D.; Bolokadze, N.; Kirk, O.; Karpov, I.; Vassilenko, A.; Klimuk, D.; Skrahin, A.; Kondratenko, O.; Zalutskaya, A.; Bondarenko, V.; Kozorez, E.; Tumash, O.; Suetnov, O.; Iljina, V.; Kummik, T.; Mshvidobadze, K.; Lanchava, N.; Goginashvili, L.; Mikiashvili, L.; Bablishvili, N.; Rozentale, B.; Zeltina, I.; Janushkevich, I.; Caplinskiene, I.; Caplinskas, S.; Wiercinska-Drapalo, A.; Thompson, M.; Kozlowska, J.; Bura, M.; Knysz, B.; Garlicki, A.; Loster, J.; Duiculescu, D.; Rakhmanova, A.; Panteleeva, O.; Yakovlev, A.; Kozlov, A.; Tyukalova, A.; Vlasova, Y.; Trofimov, T.; Kyselyova, G.; Obel, N.; Gerstoft, J.; Kronborg, G.; Payen, M. C.; Kabeya, K.; Necsoi, C.; Dabis, F.; Tsaranazy, A.; Cazanave, C.; Furrer, H.; Sagette, M.; Rickenbach, M.; Elzi, L.; Battegay, M.; Furrer, H.; Sculier, D.; Calmy, A.; Cavassini, M.; Bruno, A.; Bernasconi, E.; Hoffmann, M.; Vernazza, P.; Fehr, J.; Weber, R.; Vora, N.; Cooke, G.; Mullaney, S.; Wilkins, E.; George, V.; Collini, P.; Dockrell, D.; Campbell, L.; Brum, R.; Mabonga, E.; Saigal, P.; Kegg, S.; Ainsworth, J.; Waters, A.; Dhar, J.; Ellis, K.; Spallanzani, O. L.; Girardi, E.; Rianda, A.; Galati, V.; Pinnetti, C.; Tommasi, C.; San Gerardo, A. O.; Lapadula, G.; Di Biagio, A.; Parisini, A.; Carbonara, S.; Angarano, G.; Purgatorio, M.; Matteelli, A.; Apostoli, A.; Miro, J. M.; Manzardo, C.; Ligero, C.; Gonzalez, J.; Martinez-Martinez, J. A.; Sanchez, F.; Knobel, H.; Salvado, M.; Lopez-Colomes, J. L.; Martinez-Lacasa, X.; Cuchi, E.; Falco, V.; Curran, A.; Tortola, M. T.; Ocana, I.; Vidal, R.; Sambeat, M. A.; Pomar, V.; Coll, P.; Pozamczer, D.; Saumoy, M.; Alcaide, F.; Cayla, J.; Moreno, A.; Millet, J. P.; Orcau, A.; Fina, L.; Romero, A.; Roldan, L. L.; Iribarren, J. A.; Ibarguren, M.; Moreno, S.; Gonzalez, A.; Miralles, P.; Aldamiz-Echevarria, T.; Losso, M.; Toibaro, J.; Gambardella, L.; Ramos Mejia, J. M.; Toibaro, J.; Moreno Macias, L.; Warley, E.; Tavella, S.; Garcia Messina, O.; Gear, O.; Laplume, H.; Marson, C.; Contarelia, J.; Michaan, M.; Scapellato, P.; Bartoletti, B.; Palmero, D.; Elias, C.; Cortes, C.; Crabtree, B.; Mosqueda Gomez, J. L.; Villanueva, J. A.; Gonzalez Hernandez, L. A.; Badial, F.

doi:10.1111/hiv.13016

Background: In a 2013 survey, we reported distinct discrepancies in delivery of tuberculosis (TB) and HIV services in eastern Europe (EE) vs. western Europe (WE). Objectives: To verify the differences in TB and HIV services in EE vs. WE. Methods: Twenty-three sites completed a survey in 2018 (EE, 14; WE, nine; 88% response rate). Results were compared across as well as within the two regions. When possible, results were compared with the 2013 survey. Results: Delivery of healthcare was significantly less integrated in EE: provision of TB and HIV services at one site (36% in EE vs. 89% in WE; P = 0.034), and continued TB follow-up in one location (42% vs. 100%; P = 0.007). Although access to TB diagnostics, standard TB and HIV drugs was generally good, fewer sites in EE reported unlimited access to rifabutin/multi-drug-resistant TB (MDR-TB) drugs, HIV integrase inhibitors and opioid substitution therapy (OST). Compared with 2013, routine usage of GeneXpert was more common in EE in 2018 (54% vs. 92%; P = 0.073), as was access to moxifloxacin (46% vs. 91%; P = 0.033), linezolid (31% vs. 64%; P = 0.217), and bedaquiline (0% vs. 25%; P = 0.217). Integration of TB and HIV services (46% vs. 39%; P = 1.000) and provision of OST to patients with opioid dependency (54% vs. 46%; P = 0.695) remained unchanged. Conclusion: Delivery of TB and HIV healthcare, including integration of TB and HIV care and access to MDR-TB drugs, still differs between WE and EE, as well as between individual EE sites.