Sub-Saharan Africa faces alarming AIDS-related mortality rates, with advanced HIV disease (AHD) accounting for 60% of deaths. Every year, 460,000 people in the region succumb to AIDS-related illnesses, primarily due to delayed care. The stark reality: 34% of people living with HIV (PLHIV) remain undiagnosed, while 25% initiate treatment with severe immune suppression. Tuberculosis (TB) and opportunistic infections exacerbate this crisis. To combat this, groundbreaking research within the Xpatial-TB intervention pioneers’ community-based TB contact tracing. This innovative approach swiftly connects patients with World Health Organization (WHO)-recommended same-day care, bridging the gap between detection and treatment for advanced HIV.
The Need for Improved HIV Care
Despite global efforts to reduce HIV incidence and AIDS-related deaths, a significant proportion of people with HIV still present in healthcare systems with advanced HIV disease. AHD is defined as having a CD4 cell count of fewer than 200 cells/μL or being in stage 3 or 4 of HIV, as per WHO guidelines. People with AHD are at a high risk of contracting opportunistic infections such as TB and cryptococcosis, both of which are significant contributors to AIDS-related deaths.
The WHO recommends a package of interventions for people with AHD. These include quick infection screening, timely treatments, and the fast-tracked antiretroviral therapy (ART) start. However, many healthcare settings struggle to implement these measures effectively, especially in low-income areas where HIV and TB are most prevalent.
The Xpatial-TB Approach
The Xpatial-TB project, launched in 2018 in Manhiça District, Mozambique, focuses on contact tracing for people in close contact with individuals diagnosed with TB. This study aims to integrate the detection and management of advanced HIV into this TB contact-tracing system. The goal is to provide same-day, WHO-recommended care for those living with HIV, ensuring they receive the medical attention they need without unnecessary delays.
Between June and December 2018, PLHIV aged 14 and older were invited to participate in the study if they were either newly diagnosed, ART-naïve, or had poor adherence to ART. Those who consented were screened for AHD and, if found to be at risk, were given a package of interventions, including tests for cryptococcal antigen (CrAg) and TB-lipoarabinomannan (TB-LAM), as well as treatments for opportunistic infections and support for adherence to ART.
WHO-Recommended Care in a Single Visit
One key advantage of this approach is that it allows patients to receive a full package of care in a single visit. This is crucial in settings where repeated visits often lead to high dropout rates, with many patients failing to return for follow-up care. By using point-of-care diagnostics, such as CrAg and TB-LAM tests, healthcare providers can quickly identify infections and start treatment immediately, improving patient outcomes and reducing the spread of HIV and TB in the community.
Conclusion
The Xpatial-TB initiative, combined with community-based contact tracing, offers a promising solution to the challenges of managing advanced HIV disease in sub-Saharan Africa. By integrating HIV care into existing TB interventions and providing same-day treatment, this approach has the potential to reduce AIDS-related deaths and improve the quality of life for people living with HIV.