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Implementation of programmatic management of latent tuberculosis infection in HIV-infected people in Lithuania

Grantee

Vilnius University, Vilnius, Lithuania

Project start

March 2023

Main applicant and principal investigator

Prof. Raimonda Matulionyte, Vilnius University

Deputy applicant and project coordinator

Elzbieta Matulyte, PhD student, Vilnius University

Collaborators

  1. Edvardas Danila, Head of Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos; Vilnius University, Faculty of Medicine, Institute of Clinical Medicine, Clinic of Chest Diseases, Immunology, and Allergology
  2. Robertas Badaras, Head of Toxicology centre, Republican Vilnius University Hospital; Vilnius University, Faculty of Medicine, Clinic of Anaesthesiology and Intensive Care
  3. Giedrius Likatavicius, Head of Vilnius Branch of Republican Centre for Addictive Disorders
  4. Rasa Girdziuniene, Head of Infectious Diseases Unit, Department of Infectious Diseases, Klaipeda University Hospital
  5. Aidas Kausas, Head of Adult Infectious Diseases Unit, Clinic of Conservative Medicine, Republican Siauliai County Hospital.

Background

Tuberculosis (TB) continues to be a serious public health problem in Lithuania and is the leading cause of death among people living with HIV (PLHIV). It is the most common AIDS-indicative disease (>50% in 2019), more common than in any other EU/EEA country. Prevention of active TB disease by treatment of latent TB infection (LTBI) is a critical component of the WHO End TB Strategy. Since mid-2018, interferon gama release assay (IGRA) testing has been included into Lithuanian HIV management guidelines, but no further steps after positivity detection are described. Given the complicated epidemiological TB situation, Lithuania urgently needs a policy for programmatic management of LTBI among PLHIV. The WEEPI stage 1 project clearly demonstrated that injecting drug use is a common driver of the HIV, TB and HCV syndemic in Lithuania, similarly to other Eastern European countries.

Objective

This stage 2 project will identify the required components for programmatic LTBI control, develop national guidelines and implement programmatic management of LTBI among PLHIV in Lithuania, taking into account country-specific factors defined during the stage 1 WEEPI project. The project aims at enabling better identification of at-risk populations for LTBI testing and treatment and define the best interventions to ensure timely linkage to care following an HIV, HCV and LTBI diagnosis, develop a comprehensive and systematic strategy for LTBI management, prepare national guidelines for programmatic LTBI control among PLHIV in Lithuania and develop methods and material for the information and education strategy for different levels of society.

Methods

The study will be conducted at seven distinctive sites: four infectious diseases departments, a Toxicology centre; Centre for Addictive Disorders and a Hospital Dermatovenerology Centre. A cross-sectional study will assess population groups who are at increased risk for LTBI in Lithuania; explore the best pathways to enhance linkage to care and treatment among individuals screened positive for LTBI, HIV and/or HCV; and assess prevalence and associated risk factors for LTBI among PLHIV (N=250) and HIV uninfected individuals (N=1080) in Lithuania. A cohort of 20 to 40 PLHIV screened positive for LTBI during the WEEPI stage 1 and 2 projects combined will be established to describe and compare clinical and diagnostic work-up algorithms for LTBI. An expert group of national and international experts will develop a comprehensive and systematic strategy for programmatic LTBI control in PLHIV in Lithuania and draft the national guidelines based on the project findings. The group will also develop materials for dissemination and education of various groups, including patient groups, community workers, healthcare workers and policy makers.

Output / impact

The project will serve as a base for the comprehensive programmatic management of LTBI among people living with HIV in Lithuania. Based on this strategy, national recommendations for programmatic management of LTBI will be created and harmonized with other activities in the area of TB elimination in response to the WHO End TB Strategy and the next national Action plan for HIV/AIDS and STI Prevention and Control. It will be integrated into the existing Lithuanian HIV/AIDS guidelines, and a long-term benefit to individual and public health is expected. The WEEPI stage 1 clearly demonstrate that injecting drug use is a common driver of the HIV, TB and HCV epidemics in Lithuania. This is a strong argument supporting the need for integrated HIV, TB, HCV and substance abuse treatment services to provide person-centered rather than disease-centered care. The project will enable implementation of educational activities, reduce barriers to testing for LTBI and HIV/HCV, raise the awareness about LTBI and active TB among patient population and health care providers. It will also facilitate interdisciplinary collaboration and the partnership with other geographically distinct centres and facilitate knowledge and better equity in quality of care across the country.