title: Implementation of Tuberculosis Intensive Case Finding, Isoniazid Preventive Therapy, and Infection Control ("Three I's") and HIV-Tuberculosis Service Integration in Lower Income Countries.
abstract: METHODS
  World Health Organization advocates for integration of HIV-tuberculosis (TB) services and recommends intensive case finding (ICF), isoniazid preventive therapy (IPT), and infection control ("Three I's") for TB prevention and control among persons living with HIV.
  
  
  OBJECTIVE
  To assess the implementation of the "Three I's" of TB-control at HIV treatment sites in lower income countries.
  
  
  METHODS
  Survey conducted between March-July, 2012 at 47 sites in 26 countries: 6 (13%) Asia Pacific, 7 (15%), Caribbean, Central and South America, 5 (10%) Central Africa, 8 (17%) East Africa, 14 (30%) Southern Africa, and 7 (15%) West Africa.
  
  
  RESULTS
  ICF using symptom-based screening was performed at 38% of sites; 45% of sites used symptom-screening plus additional diagnostics. IPT at enrollment or ART initiation was implemented in only 17% of sites, with 9% of sites providing IPT to tuberculin-skin-test positive patients. Infection control measures varied: 62% of sites separated smear-positive patients, and healthcare workers used masks at 57% of sites. Only 12 (26%) sites integrated HIV-TB services. Integration was not associated with implementation of TB prevention measures except for IPT provision at enrollment (42% integrated vs. 9% non-integrated; p = 0.03).
  
  
  CONCLUSIONS
  Implementation of TB screening, IPT provision, and infection control measures was low and variable across regional HIV treatment sites, regardless of integration status.
authors.affiliation: Vanderbilt Univ. School of Medicine, Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee, United States of America.
authors.forename: M Katherine
authors.initials: MK
authors.lastname: Charles
authors.affiliation: Vanderbilt Univ. School of Medicine, Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee, United States of America.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Lindegren
authors.affiliation: Vanderbilt Univ. School of Medicine, Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee, United States of America.
authors.forename: C William
authors.initials: CW
authors.lastname: Wester
authors.affiliation: Vanderbilt Univ. School of Medicine, Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee, United States of America.
authors.forename: Meridith
authors.initials: M
authors.lastname: Blevins
authors.affiliation: Vanderbilt Univ. School of Medicine, Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee, United States of America.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Sterling
authors.affiliation: National Hospital of Tropical Diseases, Hanoi, Vietnam.
authors.forename: Nguyen Thi
authors.initials: NT
authors.lastname: Dung
authors.affiliation: Women's Equity in Access to Care & Treatment, Kigali, Rwanda.
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Dusingize
authors.affiliation: MTCTPlus, Abidjan, Cote d'Ivoire.
authors.forename: Divine
authors.initials: D
authors.lastname: Avit-Edi
authors.affiliation: TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Durier
authors.affiliation: Infectious Disease Institute, Kampala, Uganda.
authors.forename: Barbara
authors.initials: B
authors.lastname: Castelnuovo
authors.affiliation: Rakai Health Sciences Program, Kalisizo, Uganda.
authors.forename: Gertrude
authors.initials: G
authors.lastname: Nakigozi
authors.affiliation: University of Chile School of Medicine, Santiago, Chile.
authors.forename: Claudia P
authors.initials: CP
authors.lastname: Cortes
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Marie
authors.initials: M
authors.lastname: Ballif
authors.affiliation: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.|Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Fenner
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control*; D000349:Africa; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001208:Asia; D017691:Caribbean Region; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D017053:Infection Control; D007538:Isoniazid / Q000627:therapeutic use*; D011203:Poverty; D013020:South America; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control*; D014944:World Health Organization
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid