title: Tuberculosis, injecting drug use and integrated HIV-TB care: a review of the literature.
abstract: BACKGROUND
  People who inject drugs (PWID) are at increased risk of tuberculosis (TB) and reduced retention in treatment. There is a need to document strategies for integrated delivery of HIV, TB and drug dependency care.
  
  
  METHODS
  This article reviews the literature on rates of TB mono- and co-infection, and published and grey literature descriptions of TB and HIV-TB care, among PWID.
  
  
  RESULTS
  Latent TB infection prevalence was high and active disease more common among HIV-positive PWID. Data on multidrug-resistant TB and co-infections among PWID were scarce. Models of TB care fell into six categories: screening and prevention within HIV-risk studies; prevention at TB clinics; screening and prevention within needle-and-syringe-exchange (NSP) and drug treatment programmes; pharmacy-based TB treatment; TB service-led care with harm reduction/drug treatment programmes; and TB treatment within drug treatment programmes. Co-location with NSP and opioid substitution therapy (OST), combined with incentives, consistently improved screening and prevention uptake. Small-scale combined TB treatment and OST achieved good adherence in diverse settings. Successful interventions involved collaboration across services; a client-centred approach; and provision of social care. No peer-reviewed studies described models of integrated HIV-TB care for PWID but grey literature highlighted key components: co-located services, provision of drug treatment, multidisciplinary staff training; and remaining barriers: staffing inefficiencies, inadequate funding, police interference, and limited OST availability.
  
  
  CONCLUSIONS
  Integration with drug treatment improves PWID engagement in TB services but there is a need to document approaches to HIV-TB care, improve surveillance of TB and co-infections among PWID, and advocate for improved OST availability.
authors.affiliation: Centre for Research on Drugs and Health Behaviour, London School of Hygiene & Tropical Medicine, London, UK. pippa.grenfell@lshtm.ac.uk
authors.forename: Pippa
authors.initials: P
authors.lastname: Grenfell
authors.forename: Ricardo
authors.initials: R
authors.lastname: Baptista Leite
authors.forename: Richard
authors.initials: R
authors.lastname: Garfein
authors.forename: Smiljka
authors.initials: S
authors.lastname: de Lussigny
authors.forename: Lucy
authors.initials: L
authors.lastname: Platt
authors.forename: Tim
authors.initials: T
authors.lastname: Rhodes
mesh_terms: D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D018671:Needle-Exchange Programs / Q000379:methods; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000628:therapy*; D014376:Tuberculosis / Q000453:epidemiology* / Q000628:therapy*