Linking Children and Adolescents With TB Disease to HIV Services in 16 PEPFAR-supported High TB/HIV-Burden Countries in Sub-Saharan Africa, October 2018-September 2022

Abstract

Introduction: Promptly identifying children and adolescents living with both tuberculosis (TB) disease and human immunodeficiency virus (HIV) and ensuring they receive antiretroviral treatment (ART) can reduce TB/HIV-associated mortality. We reviewed linkage of children and young adolescents with TB to HIV services at clinical sites in 16 high TB/HIV-burden sub-Saharan African countries supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).

Methods: PEPFAR monitoring, evaluation and reporting data describing persons <15 years of age with TB disease during October 2018-September 2022 were reviewed. Indicators included known HIV status (proportion of clients with TB who have known HIV status), HIV positivity (proportion with TB and known HIV status who have HIV, including those newly identified and those already diagnosed with HIV) and ART linkage (proportion with TB/HIV coinfection who were receiving ART). Data were collected quarterly except for ART linkage (collected annually starting in October 2021). Trend performance of indicators during the 4-year period by quarter and annual performance, stratified by sex, age, geographic region and ART status in the final year are described.

Results: Among children and adolescents <15 years old with TB during October 2018-September 2022, known HIV status quarterly coverage increased (90% [October-December 2018] to 91% [July-September 2022]); HIV positivity decreased (22%-14%), including newly positive (7%-4%); and ART coverage increased (90%-97%). In total, during October 2021-September 2022, among 73,183 children with TB, 93% (n = 67,968) had a known HIV status, of which 14% (9295/67,968) were positive (4% newly identified [2730/67,968] and 10% already diagnosed [6565/67,968]). Of 9295 with TB/HIV, 97% (9050/9295) were currently or newly started on ART. Known HIV status was lower among infants <1 year (74%, 4883/6605), and ART linkage was lower among children <1 (93%, 502/542) and 1-4 years of age (93%, 2791/2993).

Conclusions: These findings highlight effective PEPFAR-supported integration of HIV services into TB services; however, gaps among young children persist. While HIV positivity decreased among children and adolescents with TB, universal HIV testing of those with TB remains an important strategy to close pediatric HIV treatment gaps and reduce mortality in high-burden countries.

Keywords: HIV; TB; TB case finding; TPT; adolescents; pediatrics.