Background: 

Tuberculosis preventive treatment (TPT) is a critical intervention to reduce tuberculosis mortality among people living with HIV (PLHIV). To facilitate scale-up of TPT among PLHIV, the Nigeria Ministry of Health and the US Centers for Disease Control and Prevention (CDC) Nigeria, supported by US President's Emergency Plan for AIDS Relief implementing partners, launched a TPT-focused technical assistance strategy in high-volume antiretroviral treatment (ART) sites during 2018.

Setting: 

Nigeria has an estimated 1.9 million PLHIV, representing the second largest national burden of PLHIV in the world, and an estimated 53% of PLHIV are on ART.

Methods: 

In 50 high-volume ART sites, we assessed readiness for TPT scale-up through use of a standardized tool across the following 5 areas: clinical training, community education, patient management, commodities and logistics management, and recording and reporting. We deployed a site-level continuous quality improvement strategy to facilitate TPT scale-up. Implementing partners rapidly disseminated best practices from these sites to across all CDC-supported sites and reported aggregate data on monthly TPT initiations.

Results: 

Through this targeted assistance and rapid dissemination of best practices to all other sites, the number of PLHIV who initiated TPT across all CDC-supported sites increased from 6622 in May 2018, when the approach was implemented, to 48,661 in September 2018. Gains in monthly TPT initiations were sustained through March 2019.

Conclusions: 

Use of a standardized tool for assessing readiness for TPT scale-up provided a “checklist” of potential barriers to TPT scale-up to address at each site. The quality improvement approach allowed each site to design a specific plan to achieve desired TPT scale-up, and best practices were implemented concurrently at other, smaller sites. The approach could assist scale-up of TPT among PLHIV in other countries.

中文翻译：

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通过向大批量抗逆转录病毒治疗地点提供有针对性的技术援助，在艾滋病毒携带者中预防结核病的计划性扩大规模（尼日利亚），2018-2019年

背景： 

预防结核病（TPT）是降低艾滋病毒感染者（PLHIV）结核病死亡率的关键干预措施。为了便于规模化艾滋病病毒感染者中TPT的，在尼日利亚卫生部和美国疾病控制和预防中心（CDC）的尼日利亚，美国总统紧急计划艾滋病救济执行伙伴的支持，推出了一个TPT为重点的技术援助战略2018年期间的大量抗逆转录病毒治疗（ART）站点。

设置： 

尼日利亚估计有190万艾滋病毒携带者，这是全世界艾滋病毒第二大负担，而且估计有53％的艾滋病毒携带者是接受抗逆转录病毒治疗。

方法： 

在50个高容量ART站点中，我们通过使用以下5个领域的标准化工具评估了TPT扩大的准备情况：临床培训，社区教育，患者管理，商品和物流管理以及记录和报告。我们部署了站点级别的持续质量改进策略，以促进TPT扩大规模。实施合作伙伴从这些站点向所有CDC支持的站点迅速传播了最佳实践，并报告了每月启动TPT的汇总数据。

结果： 

通过这种有针对性的援助并将最佳实践快速传播到所有其他站点，在所有CDC支持的站点中发起TPT的PLHIV感染人数从实施该方法时的2018年5月的6622人增加到2018年9月的48,661人。 TPT的启动一直持续到2019年3月。

结论： 

使用标准化工具评估TPT扩大的准备情况，为在每个站点解决TPT扩大的潜在障碍提供了“清单”。在质量改进允许每个站点设计一个具体的计划的方式来实现所需的TPT扩大规模，和最佳实践进行了其他，规模较小的网站同时实施。该方法可以帮助其他国家的艾滋病毒/艾滋病感染者扩大TPT。