Improving the monitoring of tuberculosis infections in people living with HIV in the Dominican Republic: a cascade of care model

Abstract

Among the opportunistic infections in people living with HIV (PLWHIV), infections with M. tuberculosis appear to be the most common detected. To the date it is estimated a total of 268,500 patients per year in Latin America, and the Dominican Republic it estimated 59.8 cases per 100,000 in the general population, and 12% of co-infection TB/HIV has been reported by 20161,2. This study is aim to propose a cascade of care for the TB/HIV for monitoring of interventions. We collected epidemiological data from three HIV primary care units from the two larger provinces in DR: Santo Domingo, and Santiago. Criteria for a positive TB infection were obtained from clinical records, based on clinical manifestations, and (+) baciloscopy/X-rays. Also, the criterion for a TB infection was not limited to pulmonary, but also included extrapulmonary infections (ganglionar, renal, etc). We analysed data by key populations (MSM/TG, Female Sexual Workers (FSWs), Drug uses (DU), and Migrants. A total of 5537 HIV (+) patients were enrolled in these three centres. Of those, 1% was confirmed as TB (+) (n=71). Among those TB/HIV (+) 41% received treatment, and 11% was considered cured (Figure 1). Among key populations, treatment access was higher (40% GP vs 46% KPs), however, cure rate was lower among KPs (8%) compared with GP (13%). Within those KPs: FSWs and MSM/TG were lower compared with migrants and DU (0% and 9%, respectively). This study revealed a disparity on access to care for tuberculosis treatment between general population and key populations; early access to care, and specific barriers of retention and early management might influence this. When compared between each KP, the lower rate of cure was observed in FSWs and MSM/ TG, these findings are consistent with other studies from the DR where we also observed lower rates of retention in care and not achieving the final goal of finalizing TB treatment. Seems to be a subregistry of TB/HIV cases based on current epidemiological data from the region. This propose model of cascade of care is based on data reported and it is necessary a more intensive screening and retention to achieve the goal of a free TB generation by 2020.