Weepi

Run-up to programmatic management of latent tuberculosis infection in HIV-infected people in Lithuania

Grantee

Vilnius University, Vilnius, Lithuania

Main applicant and principal investigator

Prof. Raimonda Matulionyte, Vilnius University

Deputy applicant

Elzbieta Matulyte, PhD student, Vilnius University

Collaborators 

  1. Zavinta Kancauskiene, University Hospital of Klaipeda, Lithuania
  2. Aidas Kausas, Republican Siauliai County Hospital, Lithuania

Background

Tuberculosis (TB) continues to be a 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 2018), more common than in any other EU/EEA country. The prevention of active TB disease by treatment of latent TB infection (LTBI) is a critical component of WHO End TB Strategy. However, until June 2018 PLHIV were not screened for LTBI in Lithuania. Therefore, LTBI prevalence is neither known among PLHIV nor the general population and no special actions have been taken to prevent active disease at a population level.

Objective

The study objective is to evaluate the background situation of active and latent TB infection in PLHIV in Lithuania (including prevalence and risk factors), describe selected country-specific circumstances (including current LTBI screening strategies) and to determine optimal diagnostic tools for successful implementation of programmatic management of LTBI in PLHIV in Lithuania.

Methods

A retrospective cohort analysis will be performed to assess morbidity and prevalence of active TB among persons diagnosed with HIV during the past ten years using various national databases. LTBI prevalence will be assessed by recruiting and testing 200 HIV-positive and 400 HIV-negative patients using Interferon Gamma Release Assay (IGRA) tests followed by tuberculin skin tests (TST); LTBI risk factors will be evaluated by administering a structured questionnaire to both study groups. PLHIV with a positive TST and/or IGRA result will be further screened for active TB (clinical symptoms, chest X-ray and sputum culture) and the sensitivity, specificity, positive and negative predictive values of the clinical and radiological investigations will be measured.

Output / impact

The results of the study will form the basis for improving the programmatic management of LTBI in PLHIV in Lithuania. The findings will also serve as input into the next national HIV/sexually transmitted infections (STI) action plan and will be issued as scientific advice on programmatic LTBI control in the next national TB strategy. Additionally, the project will form the basis for an educational program aiming to increase the general awareness of the importance of detection and treatment of LTBI.