title: Implementation of latent tuberculosis screening in HIV care centres: evaluation in a low tuberculosis incidence setting.
abstract: The screening and treatment of latent tuberculosis infection (LTBI) to prevent active tuberculosis (TB) is recommended by the WHO in all HIV-infected patients. The aim of this study was to evaluate its implementation within Belgium's HIV care. A multiple-choice questionnaire was sent to 55 physicians working in the country's AIDS reference centres. Response rate reached 62%. Only 20% screened all their HIV-infected patients for LTBI. Screening methods used and their interpretation vary from one physician to another. The main barriers to the implementation of LTBI screening and treatment, as perceived by the participants, are lack of sensitivity of screening tools, risks associated with polypharmacy and toxicity of treatment. The poor coverage of LTBI screening reported here and the inconsistency in methods used raises concern. However, this was not unexpected as, in low-TB incidence countries, who, when and how to screen for LTBI remains unclear and published guidelines show important disparities. Recently, a targeted approach in which only HIV-infected patients at highest risk of TB are screened has been suggested. Such a strategy would limit unnecessary exposure to LTBI treatment. This methodology was approved by 80% of the participants and could therefore achieve greater coverage. Its clinical validation is still pending.
authors.affiliation: Immunodeficiency Unit,Hôpital Erasme,Brussels,Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Wyndham-Thomas
authors.affiliation: Immunodeficiency Unit,Hôpital Erasme,Brussels,Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Schepers
authors.affiliation: Laboratory of Vaccinology and Mucosal Immunology,Université Libre de Bruxelles,Brussels,Belgium.
authors.forename: V
authors.initials: V
authors.lastname: Dirix
authors.affiliation: Laboratory of Vaccinology and Mucosal Immunology,Université Libre de Bruxelles,Brussels,Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Mascart
authors.affiliation: Immunodeficiency Unit,Hôpital Erasme,Brussels,Belgium.
authors.forename: J-P
authors.initials: JP
authors.lastname: Van Vooren
authors.affiliation: Immunodeficiency Unit,Hôpital Erasme,Brussels,Belgium.
authors.forename: J-C
authors.initials: JC
authors.lastname: Goffard
mesh_terms: D001530:Belgium / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology; D015994:Incidence; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D008403:Mass Screening / Q000379:methods* / Q000523:psychology; D010820:Physicians / Q000523:psychology; D018570:Risk Assessment; D011795:Surveys and Questionnaires
keywords: HIV/AIDS; prevention; screening programme; tuberculosis (TB)