Reviewing Screening Practices and Management of Latent Tuberculosis Infection in HIV patients from Central and Eastern Europe

Grantee

Euroguidelines in Central and Eastern Europe (ECEE) Network Group

Project start

April 2023

Main applicant and principal investigator

Justyna Kowalska, Prof, President for the ECEE Network Group

Deputy applicant

Dominik Bursa, MD, Secretary of the ECEE Network Group

Background

Tuberculosis (TB) remains a top killer among people living with HIV. Active TB develops mainly through re-activation of latent TB infection (LTBI) and is, thus, preventable. Risk of LTBI re-activation in people living with HIV is 20-30-fold higher than in the background population. Antiretroviral therapy (ART) significantly decreases this risk but not to the level of the background population. TB preventive treatment (TPT) decreases the risk of TB re-activation in people living with HIV by approximately 30%, regardless of ART. WHO estimates that one fourth of the world’s population has LTBI and that less than 5% of those infected are diagnosed and treated to prevent active TB. Central and eastern Europe (CEE) have the highest rates of TB/HIV coinfection and the largest reservoir of LTBI in Europe. Management of LTBI is a key component of the Global End TB Strategy. Strategies for LTBI screening and management in CEE have not been assessed.

Objective

The overall long-term aim of the project is to improve management of LTBI in people living with HIV and, thus, to contribute to the reduction of TB-morbidity and mortality and achievement of the End TB Strategy goals. The specific project objectives are to: 1) perform a baseline assessment of current national policies and practices on screening and management of LTBI in people living with HIV across countries of Eastern and Central Europe; 2) identify challenges and opportunities to scale up programmatic management of LTBI and 3) establish an international platform for future LTBI research by setting-up a cohort of people living with LTBI.

Methods

The study will be conducted within the Euroguidelines in Central and Eastern Europe (ECEE) Network Group which brings together experts in the field of infectious diseases from 24 countries across the CEE region, representing both high and low TB, MDR-TB and HIV prevalence and incidence settings. Objectives 1-2 will be addressed through a survey conducted among members of the ECEE Network. The survey will include questions related to national policies and existing practices on LTBI management in people living with HIV and related challenges. Clinical and epidemiological data on LTBI, TB and HIV in a particular clinic and country will also be collected. A workshop dedicated to LTBI management in Europe will be proposed for the EACS 2023 conference where the survey results will be presented, and a facilitated discussion take place. In preparation for a larger stage 2 WEEPI proposal, a prospective cohort study of LTBI/HIV patients will be designed, aiming to evaluate TB incidence, risk factors for active TB in LTBI patients, and follow-up implementation of recommended interventions to improve the continuum of care.

Output / impact

This will be the first study to assess current policies and practice for the management of LTBI in the CEE region, providing the basis for building a sustainable LTBI care model and ultimately facilitating progress toward TB elimination. The direct outcome of the study will be an improved understanding of LTBI epidemiology and management in people living with HIV in CEE and identification of areas for improvement at both local and national levels. The best results will be set as a benchmark for LTBI-care at clinic and national levels in the CEE region. The study will also provide a baseline assessment that can be used for monitoring and evaluating future progress toward the targets of the WHO End TB Strategy (90% reduction of TB mortality and 80% reduction in TB incidence by 2030.). The results of the study will be applicable for similar settings elsewhere. The research scope and framework for future research will be discussed during the planned workshop which will be open for attendance by all main international stakeholders (including WHO and ECDC) and will have both clinical, public health and political impact. The project is seen as preparatory for the establishment of a larger international collaboration to address unanswered clinical, epidemiological, and public health related questions on LTBI management and risks for progression to active-TB among people living with HIV. The ECEE Network has potential to be expanded and include additional eastern European and Central Asia countries as well as clinics/countries from Western Europe.