Dados do Trabalho

Título

Management of tuberculosis infection for people living with HIV by nurses: a proof-of concept study

Introdução

Tuberculosis preventive therapy (TPT) is a vital intervention in reducing the incidence and mortality of tuberculosis (TB) in people living with HIV (PLHIV). Although WHO reported achieving targets for prescribing TPT in PLHIV globally, this is not yet a reality in Brazil. To help expand TPT coverage, in 2023, the Brazilian Ministry of Health included the management of TB infection (TBI) as a nurse's technical and legal competency. However, the effectiveness of nurse-led management of TB infection in PLHIV has not yet been evaluated.

Objetivo (s)

To assess the feasibility of the nurse-led management approach in PLHIV screened for TB infection.

Material e Métodos

This is a retrospective cohort study conducted in a TB/HIV reference center located in Manaus, Amazonas, Brazil. An outpatient clinic was established in November 2023 after training two nurses on TBI management, including screening for and managing TPT side effects. Among PLHIV who initiated TPT, we extracted clinical and laboratory data from medical records and the IL-TB system from November 2023 to April 2024, including age, sex, TPT prescriber, CD4+ count, tuberculin test results, and QuantiFERON-TB Gold Plus test results. This study was approved by the local Research Ethics Committee.

Resultados e Conclusão

Among 127 PLHIV who started TPT in the study period, 84 (66%) were male with a median age of 39 years (IQR: 29 - 46). Of those, 75 (59%) received prescriptions from nurses, and 52 (41%) from physicians. The most commonly used TPT regimen was three months of weekly rifapentine plus isoniazid (77.1%). Of 127 PLHIV initiating TPT, 57 (45%) have completed treatment to date, including 28 (49%) initiated by nurses and 29 (51%) initiated by physicians; 58 (46%) remain on treatment. The TPT was interrupted for 12 (9.4%) individuals, 4 in the physician and 8 in the nurse groups. The proportion of subjects who did not complete TPT did not differ by category of prescriber, X2 = 1.2, p > .05. In this proof-of-concept study, we demonstrated the potential for nurses to effectively manage TBI in PLHIV with no significant decline in care, thereby expanding the capacity of healthcare systems to address the dual burden of TB and HIV more efficiently.  

Palavras Chave

hiv; Tuberculosis infection; Nursing Care.