title: Programmatic and ethical challenges in the implementation of treatment-as-prevention in the context of HIV and drug-resistant tuberculosis co-infection in sub-Saharan Africa.
abstract: There is limited literature on programmatic challenges in the implementation of a treatment-as-prevention (TasP) strategy among human immunodeficiency virus (HIV) and drug-resistant tuberculosis (DR-TB) co-infected individuals in sub-Saharan Africa (SSA). This paper highlights specific programmatic challenges surrounding the implementation of this strategy among HIV and DR-TB co-infected populations in SSA. In SSA, limitations in administrative, human and financial resources and poor health infrastructure, as well as increased duration and complexity of providing long-term treatment for HIV individuals co-infected with DR-TB, pose substantial challenges to the implementation of a TasP strategy and warrant further investigation. A comprehensive approach must be devised to implement TasP strategy, with special attention paid to the sizable HIV and DR-TB co-infected populations. We suggest that evidence-informed and human rights-based guidelines for participant protection and strategies for programme delivery must be developed and tailored to maximise the benefits to those most at risk of developing HIV and DR-TB co-infection. Assessing regional circumstances is crucial, and TasP programmes in the region should be complemented by combined prevention strategies to achieve the intended goals.
authors.affiliation: a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.|b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada.
authors.forename: Dessalegn Y
authors.initials: DY
authors.lastname: Melesse
authors.affiliation: a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.|b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada.
authors.forename: Marissa
authors.initials: M
authors.lastname: Becker
authors.affiliation: a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.|b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada.
authors.forename: Leigh M
authors.initials: LM
authors.lastname: McClarty
authors.affiliation: b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada.
authors.forename: Kellee
authors.initials: K
authors.lastname: Hodge
authors.affiliation: a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.|b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada.
authors.forename: Laura H
authors.initials: LH
authors.lastname: Thompson
authors.affiliation: a Department of Community Health Sciences, The Centre for Global Public Health , University of Manitoba , Winnipeg , MB , Canada.|b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada.
authors.forename: James F
authors.initials: JF
authors.lastname: Blanchard
authors.affiliation: b Department of Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kaufert
keywords: HIV; drug-resistant tuberculosis; sub-Saharan Africa; treatment-as-prevention