A model for bringing TB expertise to HIV providers: Medical consultations to the CDC-funded Regional Tuberculosis Training and Medical Consultation Centers, 2013-2017

• Type of Material: Article
• Authors: Robyn Fernando, Emory University; Ashley C. McDowell, Emory University; Rajita Bhavaraju, Rutgers State University; Henry Fraimow, Rutgers State University; John W. Wilson, Mayo Clinic; Lisa Armitige, Heartland National TB Center; Connie Haley, University of Florida; Neela Goswami, Emory University
• Language: English
• Date: 2020-08-31
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
• License: Creative Commons Universal : Public Domain Dedication
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0236933
• Title of Journal or Parent Work: PLoS ONE
• Volume: 15
• Issue: 8
• Start Page: e0236933
• End Page: e0236933
• Grant/Funding Information: The author(s) received no specific funding for this work.
• Keywords: Science & Technology - Other Topics; Initiation; Infection; Science & Technology; Antiretroviral therapy; Multidisciplinary Sciences
• Research Categories: Biology, Virology; Health Sciences, Epidemiology; Health Sciences, Public Health; Health Sciences, Rehabilitation and Therapy

Abstract

Background Persons living with human immunodeficiency virus (HIV) are at a greater risk of developing tuberculosis (TB) compared to people without HIV and of developing complications due to the complexity of TB/HIV coinfection management. Methods During 2013–2017, the Centers for Disease Control and Prevention (CDC) funded 5 TB Regional Training and Medical Consultation Centers (RTMCCs) (now known as TB Centers of Excellence or COEs) to provide medical consultation to providers for TB disease and latent TB infection (LTBI), with data entered into a Medical Consultation Database (MCD). Descriptive analyses of TB/HIV-related consultations were conducted using SAS® software, version [9.4] to determine the distribution of year of consultation, medical setting and provider type, frequency of consultations regarding a pediatric (<18 years) patient, and to categorize key concepts and themes arising within consultation queries and medical consultant responses. Results Of 14,586 consultations captured by the MCD in 2013–2017, 544 (4%) were categorized as TB/HIV-related, with 100 (18%) received in 2013, 129 (24%) in 2014, 104 (19%) in 2015, 117 (22%) in 2016, and 94 (17%) in 2017. Most TB/HIV consultations came from nurses (54%) or physicians (43%) and from local (65%) or state health departments (10%). Only 17 (3%) of HIV-related consultations involved pediatric cases. Off the 544 TB/HIV consultations, 347 (64%) concerned the appropriate treatment regimen for TB/HIV or LTBI/HIV for a patient on or not on antiretroviral therapy (ART). Conclusions The data support a clear and ongoing gap in areas of specialized HIV knowledge by TB experts that could be supplemented with proactive educational outreach. The specific categories of TB/HIV inquiries captured by this analysis are strategically informing future targeted training and educational activities planned by the CDC TB Centers of Excellence, as well as guiding HIV educational efforts at regional and national TB meetings.