title: Major differences in organization and availability of health care and medicines for HIV/TB coinfected patients across Europe.
abstract: OBJECTIVE
  The aim of the study was to investigate the organization and delivery of HIV and tuberculosis (TB) health care and to analyse potential differences between treatment centres in Eastern (EE) and Western Europe (WE).
  
  
  METHODS
  Thirty-eight European HIV and TB treatment centres participating in the TB:HIV study within EuroCoord completed a survey on health care management for coinfected patients in 2013 (EE: 17 respondents; WE:21; 76% of all TB:HIV centres). Descriptive statistics were obtained for regional comparisons. The reported data on health care strategies were compared with actual clinical practice at patient level via data derived from the TB:HIV study.
  
  
  RESULTS
  Respondent centres in EE comprised: Belarus (n = 3), Estonia (1), Georgia (1), Latvia (1), Lithuania (1), Poland (4), Romania (1), the Russian Federation (4) and Ukraine (1); those in WE comprised: Belgium (1), Denmark (1), France (1), Italy (7), Spain (2), Switzerland (1) and UK (8). Compared with WE, treatment of HIV and TB in EE are less often located at the same site (47% in EE versus 100% in WE; P < 0.001) and less often provided by the same doctors (41% versus 90%, respectively; P = 0.002), whereas regular screening of HIV-infected patients for TB (80% versus 40%, respectively; P = 0.037) and directly observed treatment (88% versus 20%, respectively; P < 0.001) were more common in EE. The reported availability of rifabutin and second- and third-line anti-TB drugs was lower, and opioid substitution therapy (OST) was available at fewer centres in EE compared with WE (53% versus 100%, respectively; P < 0.001).
  
  
  CONCLUSIONS
  Major differences exist between EE and WE in relation to the organization and delivery of health care for HIV/TB-coinfected patients and the availability of anti-TB drugs and OST. Significant discrepancies between reported and actual clinical practices were found in EE.
authors.affiliation: CHIP (Centre for Health and Infectious Disease Research), Department of Infectious Diseases, Section 2100, Rigshospitalet - University of Copenhagen, Copenhagen, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Mansfeld
authors.affiliation: Research Institute of Pulmonology and Pulmonary Tuberculosis, Minsk, Belarus.
authors.forename: A
authors.initials: A
authors.lastname: Skrahina
authors.affiliation: Department of Infection and Population Health, University College London Medical School, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Shepherd
authors.affiliation: Department of Infection and Population Health, University College London Medical School, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Schultze
authors.affiliation: TB Hospital #2, St Petersburg, Russia.|St Petersburg AIDS Centre, St Petersburg, Russia.
authors.forename: A M
authors.initials: AM
authors.lastname: Panteleev
authors.affiliation: Centre for Sexual Health & HIV Research, Mortimer Market Centre, University College London, London, UK.
authors.forename: R F
authors.initials: RF
authors.lastname: Miller
authors.affiliation: Infectious Diseases Service, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Miro
authors.affiliation: Infectology Centre of Latvia, Riga, Latvia.
authors.forename: I
authors.initials: I
authors.lastname: Zeltina
authors.affiliation: 'Dr Victor Babes' Hospital of Tropical and Infectious Diseases, Bucharest, Romania.|'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: S
authors.initials: S
authors.lastname: Tetradov
authors.affiliation: Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Furrer
authors.affiliation: CHIP (Centre for Health and Infectious Disease Research), Department of Infectious Diseases, Section 2100, Rigshospitalet - University of Copenhagen, Copenhagen, Denmark.
authors.forename: O
authors.initials: O
authors.lastname: Kirk
authors.affiliation: Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Grzeszczuk
authors.affiliation: Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia.
authors.forename: N
authors.initials: N
authors.lastname: Bolokadze
authors.affiliation: Institute of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Matteelli
authors.affiliation: King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: F A
authors.initials: FA
authors.lastname: Post
authors.affiliation: CHIP (Centre for Health and Infectious Disease Research), Department of Infectious Diseases, Section 2100, Rigshospitalet - University of Copenhagen, Copenhagen, Denmark.
authors.forename: J D
authors.initials: JD
authors.lastname: Lundgren
authors.affiliation: Department of Infection and Population Health, University College London Medical School, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Mocroft
authors.affiliation: CHIP (Centre for Health and Infectious Disease Research), Department of Infectious Diseases, Section 2100, Rigshospitalet - University of Copenhagen, Copenhagen, Denmark.
authors.forename: Amw
authors.initials: A
authors.lastname: Efsen
authors.affiliation: CHIP (Centre for Health and Infectious Disease Research), Department of Infectious Diseases, Section 2100, Rigshospitalet - University of Copenhagen, Copenhagen, Denmark.
authors.forename: D N
authors.initials: DN
authors.lastname: Podlekareva
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D060085:Coinfection / Q000175:diagnosis / Q000188:drug therapy; D003430:Cross-Sectional Studies; D005060:Europe; D005061:Europe, Eastern; D015658:HIV Infections / Q000188:drug therapy* / Q000382:microbiology; D006306:Health Surveys; D006801:Humans; D058850:Opiate Substitution Treatment / Q000379:methods; D017828:Rifabutin / Q000627:therapeutic use; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents; D017828:Rifabutin
keywords: Europe; HIV; delivery of health care; integrated; tuberculosis