Symposium 1 - APRC 2024

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Symposium 1：TB in PLHIV

Tuberculosis (TB) remains the leading cause of death among people living with HIV (PLHIV). In 2019, TB accounted for one-third of the AIDS-related deaths and PLHIV represented approximately 15% of the total TB deaths that year. According to the 2020 Global TB Report, even when on antiretroviral therapy (ART), PLHIV are 3 times more likely to die during TB treatment. In this session, we will provide the integrated clinical models that PLHIV receive TB/LTBI screening as part of their routine care, and all TB clients receive HIV testing and counseling and are linked to follow-up services as needed. To further link clients to care, integrating systematic TB contact and household tracing strategies with HIV partner notification and index testing is also an important approach. The combination strategies further improve the TB cascade by introducing and scaling up the newest proven diagnostics, prevention and treatment regimens among PLHIV.

Date: Saturday, April 27, 2024 | Time: 08:30-10:00 (GMT+8)

Moderator: Dr. Anita Pei-Chun Chan (Taiwan) | Dr. Kasha Singh (Australia)

Time (GMT+8)	Topic	Speaker	Country / Region
08:30-09:00	Integrated strategies to find TB among PLWHAs in Viet Nam	Ms. Quynh Hoa Vu	Vietnam
09:00-09:30	Comprehensive package of HIV-TB-STI-Chem-sex care in Victoria, Australia	Dr. Kasha Singh	Australia
09:30-10:00	Experience with the governmental-funded hospital-initiated tuberculosis infection diagnosis and treatment among people living with HIV in Taiwan, 2019-2023	Prof. Chien-Ching Hung	Taiwan

Integrated strategies to find TB among PLWHAs in Viet Nam

Abstract:
Tuberculosis (TB) is the leading opportunistic infection that causes death in people living with HIV/AIDS (PLWHAs), and HIV is the strongest risk factor for developing TB among latent TB infected people. Despite of achieving remarkable results on TB control, Vietnam is still a country with high TB burden, ranks 11th among 30 countries with highest TB patients globally. National TB Control Program of Vietnam (NTP) is making every effort to reach the goal of ending TB by 2035.

Currently, the NTP is implementing TB Intensified Case Finding (ICF) using 2X strategy for PLWHAs at Methadone centers. 2X strategy which is Chest Xray (CXR) screening for all participants and Xpert test for those with abnormalities suggestive TB on CXR. Besides, the NTP has collaborated with Vietnam Administration of HIV/AIDS Control (VAAC) to conduct TB ICF for PLWHAs under US CDC’s support. PLWHAs are screened for TB by symptoms in combination with appropriate para-clinical tests (CRP, Chest Xray, LF LAM, Xpert MTB/RIF, Xpert Ultra, etc).

In 2023, the NTP conducted TB ICF using 2X strategy for PLWHAs at Methadone centers of 12 provinces. 10,314 Methadone users underwent CXR screening, 939 people (9.1%) had abnormal CXR results. 1,025 TB suspected people conducted Xpert test. 121 people (11.8 %) detected and enrolled for TB treatment (Source: NTP, Vietnam).

Within CDC/ PEPFAR supported project, among 93,263 ART patients in 10 provinces, 90,465 people screened for TB in Q4/2023 (97%). As a result, 1,990 TB cases detected (2.2 %) (Source: PEPFAR Vietnam).

To optimize the effectiveness of TB ICF for PLWHAs, contribute to increase TB detection and treatment, it is necessary to mobilize various resources to implement and expand integrated strategies on TB screening for PLWHAs; strengthen capacity of all-level TB/HIV staff; and apply standardized TB/HIV monitoring tool.

Ms. Quynh Hoa Vu

Member of Strategy-Planning and Logistics Unit/ Technical Unit | Vietnam National Lung Hospital/ National Tb Control Program
Vietnam

Professional Experience:

Ms. Hoa has worked at Vietnam National Lung Hospital/ National Tuberculosis Control Program for 17 years. Previously, she had 3-year working experience as a project officer specializing in reproductive health at Vietnam Family Planning Association. Currently, Ms Hoa is a member of Strategy, Planning & Logistics Unit and Technical Unit of the National Tuberculosis Control Program. She has Master’s degree in Public Health from Hanoi University of Public Health, Vietnam. Ms Hoa’s areas of interest are planning for TB control activities, latent TB detection and treatment.

Comprehensive package of HIV-TB-STI-Chem-sex care in Victoria, Australia

Abstract:

Victoria is the second smallest state by land area in Australia. Conversely it is also the second most-populated state (after NSW), with a population of just under 7 million. It is the most densely populated state and is in the south-eastern corner of the country, with the bass strait and Tasmania to its south.

Victoria has a statewide TB service with complete jurisdiction over the state’s TB cases. All cases are notifiable and comprehensive care is provided free of charge. Care includes medical appointments, all investigations and treatment costs.

This contrasts with the state’s HIV and sexual health services. Theseare highly variable across providers. Recently, medications for HIV (antiretroviral therapy) became subsidised for all people living with HIV. Previously these were only subsidised under the prescriber benefits scheme for those holding a ‘medicare’ card, including Australian citizens and some visa holders.

The vulnerability of people living with HIV to opportunistic infections such as TB, and the overlap of exposure and risk with sexually transmitted infections indicates that acoordinated and integrated service would have potential benefits for both case finding and care coordination.

Dr. Kasha Singh

Infectious Diseases And Tb Specialist | The Peter Doherty Institute for Infection and Immunity
Australia

Professional Experience:

Kasha is an infectious disease physician with the Victorian Infectious Diseases Service at the Royal Melbourne Hospital. She has an interest in HIV, TB and hepatitis B and in particular the management of these in hard to reach and vulnerable people. She is an academic specialist in tuberculosis at the University of Melbourne.

Experience with the governmental-funded hospital-initiated tuberculosis infection diagnosis and treatment among people living with HIV in Taiwan, 2019-2023

Abstract:
PWH are provided with free-of-charge interferon-gamma release assay (IGRA) and treatments for LTBI in Taiwan since 2019. We investigated the care cascade of LTBI among PWH at a university hospital in Taiwan in 2019-2023. LTBI treatments include 1-month daily isoniazid (300 mg) plus rifapentine (600 mg) (1HP), 3-month weekly isoniazid (900 mg) plus rifapentine (900 mg) (3HP), 4-month daily rifampin (4R), and 9-month daily isoniazid (9H). PWH testing IGRA-positive were advised to receive directly-observed therapy for LTBI after active TB was excluded by review of clinical symptomatology and chest radiography. Overall, 3482 PWH without TB or LTBI treatment underwent IGRA testing. The majority of the included PWH were male (96.6%) (mean age, 41.6 years). Overall, 136 (4.1%) tested IGRA-positive and 35 (1.1%) had indeterminate results. 126 (92.6%) and 1 (2.9%) PWH with positive IGRA and those with indeterminate IGRA result, respectively, initiated LTBI treatment. 1HP (89/121,73.6%) and 3HP (30/121,24.8%) were the most common regimens prescribed. The most frequent ART used were coformulated bictegravir/emtricitabine/tenofovir alafenamide (96/121, 79.3%) and DTG-based regimens (21/121, 17.4%). Overall, 111 (91.7%) PWH completed LTBI treatment and 9 failed to complete LTBI treatment. The most common reasons of treatment non-completion included skin rash, nausea and general malaise. Before LTBI treatment, plasma HIV-1 RNA <200 and <50 copies/ml was 98.3% (119/121) and 93.4% (113/121), respectively, for PWH who initiated LTBI treatment; at 3-6 months of LTBI treatment completion, the respective rate of <200 and <50 copies/ml was 96.4% (106/110) and 94.5% (104/110). The screening rate for LTBI among PWH at the study site was 95.6% and the positive rate was 4.1%. About 92.6% of PWH testing positive for LTBI initiated treatment and only 8.3% failed to complete treatment due to adverse effects. Combination of 1HP or 3HP with integrase inhibitor-based antiretroviral therapy did not compromise the virologic control.

Prof. Chien-Ching Hung

Vice Superintendent | National Taiwan University Hospital Yunlin Branch
Taiwan

Professional Experience:

Chien-Ching Hung, M.D., Ph.D. joined the Division of Infectious Diseases at the National Taiwan University Hospital as a staff physician since 1996. He is currently the Professor of Department of Internal Medicine and Department of Tropical Medicine and Parasitology at the National Taiwan University College of Medicine, Taipei, and vice superintendent of National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan. Dr. Hung received his medical degree from the National Taiwan University College of Medicine in 1989. After an internship in the Department of Internal Medicine, National Taiwan University Hospital, he completed a residency training in the Department of Internal Medicine, National Taiwan University Hospital; this was followed by a fellowship in the Division of Infectious Diseases, National Taiwan University Hospital. He subsequently obtained master degree of international health at the Swiss Tropical and Public Health Institute, Basel, Switzerland in 2006, followed by PhD degree of the University of Antwerp, Antwerp, Belgium in 2009. His research interests include clinical management of HIV-related opportunistic infections, combination antiretroviral therapy, amoebiasis, sexually transmitted infections, and viral hepatitis coinfections. He has authored 430 articles in several peer-reviewed journals and, in the past several years, served as a reviewer for more than 30 journals.

Dr. Anita Pei-Chun Chan

Deputy Director Of The Division Of Chronic Infectious Diseases | Taiwan CDC
Taiwan

Professional Experience:

Dr. Anita Chan is presently the Deputy Director at the Division of Chronic Infectious Diseases, the Centers for Disease Control, Ministry of Health and Welfare, Taiwan (Taiwan CDC). She also serves as Associate Director at the Tuberculosis Research Center, Taiwan CDC. Her other positions include Standing Committee of Taiwan Guidelines for TB Diagnosis and Treatment, Adjunct Assistant Professor at the Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan. She has more than 15 years of experience on policy implementation for TB control. Important operational research papers had been published to prove the effectiveness of policy implementation of TB/HIV/STD. Her main research interests are tuberculosis, infection control, vaccination, ethics and law of notifiable diseases, and infectious diseases.

Symposium 1：TB in PLHIV

APRC 2024 Secretariat

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