Integrated HIV and TB Services for the Management of Coinfection in West Africa: A Scoping Review of Strategies, Outcomes, Barriers and Enablers.

BACKGROUND AND AIM: There is a concern about treatment outcomes for human immunodeficiency virus and tuberculosis infections in West Africa. This has led to a focus on the development of strategies for integrated care; however, data on the barriers and enablers of these strategies are limited. The scoping review aimed to map strategies for the integrated management of HIV and TB services in West Africa and identify barriers and enablers influencing implementation.

METHODS

The Arksey and O'Malley scoping review design was used for the study. The PRISMA extension for scoping review guidelines were followed meticulously. Four data sources (Scopus, PubMed, MEDLINE and CINAHL) were searched for strategies of integrated management for HIV and TB co-infection in West Africa, from January 1, 2000 to March 31, 2022. Of the 813 records screened, 22 studies met the inclusion criteria.

RESULTS

Seven key components were identified: anti-TB therapy (for active co-infection), isoniazid preventive therapy (IPT), tuberculosis infection control (TBIC), antiretroviral therapy (ART) initiation, TB testing, co-trimoxazole preventive therapy (prophylaxis), and patient education/counseling. ART initiation and TB testing showed moderate-to-high success (75%-98% testing rates), while isoniazid preventive therapy (IPT) and TBIC had poor implementation (median IPT score: 0 in Ghana; 0%-42% TBIC adherence). The treatment success rates of the integrated management of HIV and TB co-infection reached 77% in settings with robust integration although mortality remained high (15%-19.5%). Barriers included staff shortages, stigma, inadequate financing, drug shortages, infrastructure gaps and fear of adverse drug interactions. The enablers were patient education, healthcare worker training, optimized logistics and strengthened health information systems.

CONCLUSION

Integration of TB and HIV services was found to be possible in West Africa, with different degrees of effectiveness due to differences in law and local settings. Scaling up requires addressing health system barriers, enhancing training, and leveraging enablers such as patient empowerment and data-driven logistics.