Integrating TB Screening Services in Differentiated Care Models for HIV to Increase Detection of TB/HIV Coinfection

The majority of people living with HIV (PLHIV) in the DRC are screened for TB, but this may lead to missed cases of TB/HIV coinfection and high mortality, as TB is the primary cause of death among PLHIV in the country. To address this issue, the Integrated HIV/AIDS Project in Haut Katanga and Lualaba (IHAP-HK/L) introduced three differentiated care models (DCMs) that integrated TB screening and preventive therapy into the standard service package. The DCMs were designed to increase TB detection among PLHIV, and TB screening was more likely to be offered in these models than in the traditional care model. The highest proportion of TB screening was observed at PoDi+ sites, which provided a range of services, including multi-month refills of antiretroviral therapy (ART), cotrimoxazole, and isoniazid, as well as adherence counseling and TB and nutritional screenings. The DCMs were staffed by peer educators, who played a crucial role in improving the quality of service delivery. The results of the program showed that high TB screening rates were observed across all DCMs, with a cumulative TB incidence of 0.4% within the cohort. There was no statistically significant difference in cumulative TB incidence among DCMs or between DCMs and the traditional care model. The integration of TB screening into the DCMs led to earlier detection of PLHIV with TB, which underscores the necessity for continuous adaptation of service models based on patient needs to achieve global targets to end the dual epidemic. The TB screening tool developed by IHAP-HK/L was used in the DCMs, and peer educators were trained to screen PLHIV for TB at every ART pickup appointment. PLHIV who screened positive were referred to a facility for TB diagnosis and treatment initiation, while those who screened negative were initiated on isoniazid at the facility and received monthly refills in the DCMs. The program's success highlights the importance of integrating TB screening into HIV care services to improve TB case detection and reduce mortality among PLHIV.