{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:09:00Z","timestamp":1787504940259,"version":"build-2736575974"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T00:00:00Z","timestamp":1650412800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["5U2GGH000994-03"],"award-info":[{"award-number":["5U2GGH000994-03"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Tuberculosis (TB) primarily affects women during their reproductive years and contributes to maternal mortality and poor pregnancy outcomes. For pregnant women living with HIV (WLHIV), TB is the leading cause of non-obstetric maternal mortality, and pregnant WLHIV with TB are at increased risk of transmitting both TB and HIV to their infants. TB diagnosis among pregnant women, particularly WLHIV, remains challenging, and TB preventive treatment (TPT) coverage among pregnant WLHIV is limited. This project aimed to strengthen integrated TB and reproductive, maternal, neonatal and child health (RMNCH) services in Eswatini to improve screening and treatment for TB disease, TPT uptake and completion among women receiving RMNCH services. The project was conducted from April-December 2017 at four health facilities in Eswatini and introduced enhanced monitoring tools and on-site technical support in RMNCH services. We present data on TB case finding among women, and TPT coverage and completion among eligible WLHIV. A questionnaire (S1 Appendix) measured healthcare provider perspectives on the project after three months of project implementation, including feasibility of scaling-up integrated TB and RMNCH services. A total of 5,724 women (HIV-negative or WLHIV) were screened for active TB disease while attending RMNCH services; 53 (0.9%) were identified with presumptive TB, of whom 37 (70%) were evaluated for TB disease and 6 (0.1% of those screened) were diagnosed with TB. Among 1,950 WLHIV who screened negative for TB, 848 (43%) initiated TPT and 462 (54%) completed. Forty-three healthcare providers completed the questionnaire, and overall were highly supportive of integrated TB and RMNCH services. Integration of TB\/HIV services in RMNCH settings was feasible and ensured high TB screening coverage among women of reproductive age, however, symptom screening identified few TB cases, and further studies should explore various screening algorithms and diagnostics that optimize case finding in this population. Interventions should focus on working with healthcare providers and patients to improve TPT initiation and completion rates.<\/jats:p>","DOI":"10.1371\/journal.pgph.0000217","type":"journal-article","created":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T13:25:43Z","timestamp":1650461143000},"page":"e0000217","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini"],"prefix":"10.1371","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6172-1870","authenticated-orcid":true,"given":"Kieran","family":"Hartsough","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9165-8972","authenticated-orcid":true,"given":"Chloe A.","family":"Teasdale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siphesihle","family":"Shongwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Geller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7225-3096","authenticated-orcid":true,"given":"Eduarda","family":"Pimentel De Gusmao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0167-0634","authenticated-orcid":true,"given":"Phumzile","family":"Dlamini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnold","family":"Mafukidze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7409-6995","authenticated-orcid":true,"given":"Munyaradzi","family":"Pasipamire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0775-5188","authenticated-orcid":true,"given":"Trong","family":"Ao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Ryan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2143-672X","authenticated-orcid":true,"given":"Surbhi","family":"Modi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine J.","family":"Abrams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3248-1307","authenticated-orcid":true,"given":"Andrea A.","family":"Howard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,4,20]]},"reference":[{"key":"pgph.0000217.ref001","author":"WHO","year":"2020","journal-title":"Global Tuberculosis Report"},{"issue":"11","key":"pgph.0000217.ref002","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1093\/cid\/cis732","article-title":"Tuberculosis in pregnant and postpartum women: epidemiology, management, and research gaps","volume":"55","author":"JS Mathad","year":"2012","journal-title":"Clinical infectious diseases: an official publication of the Infectious Diseases Society of America"},{"issue":"5","key":"pgph.0000217.ref003","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1111\/1471-0528.14408","article-title":"Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: a systematic review and meta-analysis","volume":"124","author":"S Sobhy","year":"2017","journal-title":"BJOG: an international journal of obstetrics and gynaecology"},{"key":"pgph.0000217.ref004","author":"WHO","year":"2019","journal-title":"Global Tuberculosis Report"},{"issue":"2","key":"pgph.0000217.ref005","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1097\/AOG.0b013e3181af33e6","article-title":"Effect of human immunodeficiency virus treatment on maternal mortality at a tertiary center in South Africa: a 5-year audit","volume":"114","author":"V Black","year":"2009","journal-title":"Obstetrics and gynecology"},{"issue":"3","key":"pgph.0000217.ref006","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1093\/jinfdis\/jiq064","article-title":"Maternal tuberculosis: a risk factor for mother-to-child transmission of human immunodeficiency virus","volume":"203","author":"A Gupta","year":"2011","journal-title":"The Journal of infectious diseases"},{"key":"pgph.0000217.ref007","unstructured":"(WHO) WHO. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management Geneva, Switzerland2018."},{"issue":"9","key":"pgph.0000217.ref008","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1056\/NEJMoa1507198","article-title":"A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa","volume":"373","author":"C Danel","year":"2015","journal-title":"The New England journal of medicine"},{"issue":"11","key":"pgph.0000217.ref009","doi-asserted-by":"crossref","first-page":"e1080","DOI":"10.1016\/S2214-109X(17)30372-8","article-title":"Effect of isoniazid preventive therapy on risk of death in west African, HIV-infected adults with high CD4 cell counts: long-term follow-up of the Temprano ANRS 12136 trial","volume":"5","author":"A Badje","year":"2017","journal-title":"The Lancet Global health"},{"issue":"1","key":"pgph.0000217.ref010","first-page":"Cd000171","article-title":"Treatment of latent tuberculosis infection in HIV infected persons","volume":"2010","author":"C Akolo","year":"2010","journal-title":"The Cochrane database of systematic reviews"},{"issue":"8","key":"pgph.0000217.ref011","first-page":"Cd006418","article-title":"Isoniazid for preventing tuberculosis in HIV-infected children","volume":"8","author":"M Zunza","year":"2017","journal-title":"The Cochrane database of systematic reviews"},{"issue":"11","key":"pgph.0000217.ref012","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1016\/S1473-3099(16)30216-X","article-title":"The cascade of care in diagnosis and treatment of latent tuberculosis infection: a systematic review and meta-analysis","volume":"16","author":"H Alsdurf","year":"2016","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"pgph.0000217.ref013","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1186\/s12889-019-7769-y","article-title":"Inequality in uptake of isoniazid prevention therapy and Mantoux test among pregnant women with HIV in the Eastern Cape, South Africa","volume":"19","author":"OV Adeniyi","year":"2019","journal-title":"BMC Public Health"},{"key":"pgph.0000217.ref014","unstructured":"Eswatini GotKo, (CDC) CfDCaP, University. IaC. Swaziland HIV Incidence Measurement Survey (SHIMS2) 2016-17: Summary Sheet. Mbabane, Eswatini2018."},{"key":"pgph.0000217.ref015","unstructured":"Health EMo. National Guidelines For Implementing Tuberculosis Intensified Case Finding Isoniazid Preventive Therapy and Infection Control in health care and congregate settings. January 2012."},{"key":"pgph.0000217.ref016","unstructured":"National TB Control Programme Manual 3rd Edition .2019 Manzini."},{"issue":"2","key":"pgph.0000217.ref017","doi-asserted-by":"crossref","first-page":"103","DOI":"10.5588\/pha.15.0008","article-title":"Declining tuberculosis notification trend associated with strengthened TB and expanded HIV care in Swaziland","volume":"5","author":"S Haumba","year":"2015","journal-title":"Public health action"},{"issue":"9","key":"pgph.0000217.ref018","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1111\/tmi.13290","article-title":"Decreased risk of HIV-associated TB during antiretroviral therapy expansion in rural Eswatini from 2009 to 2016: a cohort and population-based analysis","volume":"24","author":"B Kerschberger","year":"2019","journal-title":"Tropical medicine & international health: TM & IH"},{"key":"pgph.0000217.ref019","unstructured":"UNAIDS Estimates 2019 [Available from: https:\/\/aidsinfo.unaids.org\/https:\/\/aidsinfo.unaids.org\/."},{"issue":"4","key":"pgph.0000217.ref020","doi-asserted-by":"crossref","first-page":"e77","DOI":"10.1097\/QAI.0b013e31821ac9c1","article-title":"Active tuberculosis case-finding among pregnant women presenting to antenatal clinics in Soweto, South Africa","volume":"57","author":"CR Gounder","year":"2011","journal-title":"Journal of acquired immune deficiency syndromes (1999)"},{"issue":"4","key":"pgph.0000217.ref021","doi-asserted-by":"crossref","first-page":"e62211","DOI":"10.1371\/journal.pone.0062211","article-title":"High prevalence of pulmonary tuberculosis but low sensitivity of symptom screening among HIV-infected pregnant women in South Africa","volume":"8","author":"CJ Hoffmann","year":"2013","journal-title":"PloS one"},{"issue":"1","key":"pgph.0000217.ref022","doi-asserted-by":"crossref","first-page":"837","DOI":"10.4102\/ajlm.v9i1.837","article-title":"Detecting tuberculosis in pregnant and postpartum women in Eswatini","volume":"9","author":"M Pasipamire","year":"2020","journal-title":"African journal of laboratory medicine"},{"issue":"2","key":"pgph.0000217.ref023","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1097\/QAI.0000000000000826","article-title":"Tuberculosis Case Finding in HIV-Infected Pregnant Women in Kenya Reveals Poor Performance of Symptom Screening and Rapid Diagnostic Tests","volume":"71","author":"SM LaCourse","year":"2016","journal-title":"Journal of acquired immune deficiency syndromes (1999)"},{"issue":"10","key":"pgph.0000217.ref024","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1097\/QAD.0000000000000278","article-title":"Performance of symptom-based tuberculosis screening among people living with HIV: not as great as hoped","volume":"28","author":"F Ahmad Khan","year":"2014","journal-title":"Aids"},{"issue":"1","key":"pgph.0000217.ref025","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/QAD.0000000000002715","article-title":"Tuberculosis symptom screening for children and adolescents living with HIV in six high HIV\/TB burden countries in Africa","volume":"35","author":"B Vonasek","year":"2021","journal-title":"Aids"},{"issue":"9","key":"pgph.0000217.ref026","doi-asserted-by":"crossref","first-page":"e515","DOI":"10.1016\/S2352-3018(18)30137-1","article-title":"Sensitivity and specificity of WHO\u2019s recommended four-symptom screening rule for tuberculosis in people living with HIV: a systematic review and meta-analysis","volume":"5","author":"Y Hamada","year":"2018","journal-title":"The lancet HIV"},{"key":"pgph.0000217.ref027","article-title":"Biomarker-guided tuberculosis preventive therapy (CORTIS): a randomised controlled trial","author":"TJ Scriba","year":"2021","journal-title":"Lancet Infect Dis"},{"key":"pgph.0000217.ref028","unstructured":"The First National TB Prevalence Survey, South Africa 2018: Short Report. South Africa National Department of Health."},{"key":"pgph.0000217.ref029","unstructured":"WHO consolidated guidelines on tuberculosis: Module 2: screening \u2013 systematic screening for tuberculosis disease. Geneva: World Health Organization 2021."},{"key":"pgph.0000217.ref030","unstructured":"National Policy Guidelines on TB\/HIV Collaborative Activities, 2015. Eswatini Ministry of Heatlh."},{"key":"pgph.0000217.ref031","author":"WHO","year":"2018","journal-title":"Global Tuberculosis Report"},{"issue":"6","key":"pgph.0000217.ref032","doi-asserted-by":"crossref","first-page":"596","DOI":"10.5588\/ijtld.17.0758","article-title":"TB preventive therapy for people living with HIV: key considerations for scale-up in resource-limited settings","volume":"22","author":"I Pathmanathan","year":"2018","journal-title":"The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease"},{"issue":"14","key":"pgph.0000217.ref033","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1056\/NEJMoa1813060","article-title":"Isoniazid Preventive Therapy in HIV-Infected Pregnant and Postpartum Women","volume":"381","author":"A Gupta","year":"2019","journal-title":"The New England journal of medicine"},{"issue":"6","key":"pgph.0000217.ref034","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1093\/cid\/ciz1024","article-title":"Isoniazid Preventive Therapy and Pregnancy Outcomes in Women Living With Human Immunodeficiency Virus in the Tshepiso Cohort","volume":"71","author":"N Salazar-Austin","year":"2020","journal-title":"Clinical infectious diseases: an official publication of the Infectious Diseases Society of America"},{"issue":"8","key":"pgph.0000217.ref035","doi-asserted-by":"crossref","first-page":"e351","DOI":"10.1093\/cid\/ciz1224","article-title":"Safety and Effectiveness of Isoniazid Preventive Therapy in Pregnant Women Living with Human Immunodeficiency Virus on Antiretroviral Therapy: An Observational Study Using Linked Population Data","volume":"71","author":"E Kalk","year":"2020","journal-title":"Clinical infectious diseases: an official publication of the Infectious Diseases Society of America"},{"issue":"5","key":"pgph.0000217.ref036","first-page":"570","article-title":"The PREVENT TB and the iAdhere Trials","volume":"15","author":"Exposure to Latent Tuberculosis Treatment during Pregnancy","year":"2018","journal-title":"Annals of the American Thoracic Society"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0000217","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T13:26:14Z","timestamp":1650461174000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0000217"}},"subtitle":[],"editor":[{"given":"Sabine","family":"Hermans","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,4,20]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0000217","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,20]]}}}