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Improving care for people living with HIV and multi-drug-resistant tuberculosis: an international collaboration

Grantee

Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC), Tbilisi, Georgia

Project status: Ongoing

Main applicant and principal investigator

Nikoloz Chkhartishvili, Deputy Executive Director for Research, IDACIRC

Deputy applicant

Natalia Bolokadze, Infectious Diseases Physician, IDACIRC

Collaborators 

  1. Dr. Maria Dolynska, Bogomolets National Medical University, Kyiv, Ukraine
  2. Dr Raimonda Matulionyte, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
  3. Dr Svetlana Popvici, Hospital of Dermatology and Communicable Diseases, Chisinau, Republic of Moldova
  4. Dr Marika Raukas, West-Tallinn Central Hospital, Infectious Diseases Clinic, Tallinn, Estonia
  5. Prof. Amanda Mocroft, Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), University Colleague London, London, United Kingdom
  6. Prof. Christoph Lange, German Center for Infection Research (DZIF), Borstel, Germany
  7. Prof. Ole Kirk, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark

Background

TB and HIV co-infection is common in Eastern Europe (EE) and caries special challenges in terms of high rates of multi-drug-resistant TB (MDR-TB) and high mortality. Among people living with HIV (PLWH) in EE, more than 80% with MDR-TB start an initial TB regimen composed of 3 or fewer active drugs, and on third die within one year after a diagnosis of MDR-TB, with substantial heterogeneity across countries and hospitals within EE. TB and HIV care for MDR-TB/HIV co-infected patients may differ substantially across eastern Europe. Targets for TB and HIV care are not met in all countries and clinics.

Objective

The study objective is to assess policies and practices related to care of MDR-TB/HIV co-infected patients in an international network of 5 clinics from Georgia, Ukraine, Moldova, Lithuania and Estonia, support implementation of standard of care following latest WHO and EACS strategies and guidelines and create a regional e-learning platform for continued clinical and scientific collaboration for current and future generations.

Methods

Through the network of participating clinics, strengthened by top-level expertise on HIV and TB from western European collaborators from the United Kingdom, Denmark and Germany, to 1) conduct quality assessment of services through clinical audit and benchmarking; 2) estimate the cascade of care; 3) pilot advanced e-learning training using a combination of didactic mini-lectures and case-based learning through interactive video technology.

Output / impact

The study is expected to improve the quality of care and outcomes of MDR-TB/HIV co-infected patients and identify areas for improvement both on policy and clinical practice level. The study will also create a regional platform for continued clinical and scientific collaboration and capacity building locally, nationally and internationally.