{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T23:06:28Z","timestamp":1790636788917,"version":"4.1.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T00:00:00Z","timestamp":1713225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"US Centers for Disease Control and Prevention (CDC) under PEPFAR","award":["NU2GGH002216"],"award-info":[{"award-number":["NU2GGH002216"]}]},{"name":"US Centers for Disease Control and Prevention (CDC) under PEPFAR","award":["NU2GGH002216"],"award-info":[{"award-number":["NU2GGH002216"]}]},{"name":"US Centers for Disease Control and Prevention (CDC) under PEPFAR","award":["NU2GGH002216"],"award-info":[{"award-number":["NU2GGH002216"]}]},{"name":"US Centers for Disease Control and Prevention (CDC) under PEPFAR","award":["NU2GGH002216"],"award-info":[{"award-number":["NU2GGH002216"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Tuberculosis (TB) preventive treatment (TPT) is recommended by the World Health Organization (WHO) for persons living with HIV, including pregnant and breastfeeding women. Given the President\u2019s Emergency Plan for AIDS Relief (PEPFAR)\u2019s investment in TPT services for persons living with HIV as a strategy to prevent TB as well as uncertainty in guidelines and policy regarding use of TPT during pregnancy and the postpartum period, we conducted a review of current relevant national guidelines among PEPFAR-supported countries.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Our review included 44\/49 PEPFAR-supported countries to determine if TB screening and TPT are recommended specifically for pregnant and breastfeeding women living with HIV (WLHIV). National guidelines reviewed and abstracted included TB, HIV, prevention of vertical HIV transmission, TPT, and any other relevant guidelines. We abstracted information regarding TB screening, including screening tools and frequency; and TPT, including timing, regimen, frequency, and laboratory monitoring.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of 44 PEPFAR-supported countries for which guidelines were reviewed, 66% were high TB incidence countries; 41% were classified by WHO as high TB burden countries, and 43% as high HIV-associated TB burden countries. We found that 64% (n = 28) of countries included TB screening recommendations for pregnant WLHIV in their national guidelines, and most (n = 35, 80%) countries recommend TPT for pregnant WLHIV. Fewer countries included recommendations for breastfeeding as compared to pregnant WLHIV, with only 32% (n = 14) mentioning TB screening and 45% (n = 20) specifically recommending TPT for this population; most of these recommend isoniazid-based TPT regimens for pregnant and breastfeeding WLHIV. However, several countries also recommend isoniazid combined with rifampicin (3RH) or rifapentine (3HP).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Despite progress in the number of PEPFAR-supported countries that specifically include TB screening and TPT recommendations for pregnant and breastfeeding WLHIV in their national guidelines, many PEPFAR-supported countries still do not include specific screening and TPT recommendations for pregnant and breastfeeding WLHIV.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0296993","type":"journal-article","created":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T17:35:02Z","timestamp":1713288902000},"page":"e0296993","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Guidelines for tuberculosis screening and preventive treatment among pregnant and breastfeeding women living with HIV in PEPFAR-supported countries"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0096-1306","authenticated-orcid":true,"given":"Yael","family":"Hirsch-Moverman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4304-8576","authenticated-orcid":true,"given":"Allison","family":"Hsu","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\/0000-0003-0912-7641","authenticated-orcid":true,"given":"William P.","family":"Killam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany","family":"Moore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea A.","family":"Howard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,4,16]]},"reference":[{"key":"pone.0296993.ref001","volume-title":"Global tuberculosis control: WHO report 2021","author":"World Health Organization","year":"2021"},{"issue":"3","key":"pone.0296993.ref002","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01886-2019","article-title":"Increased risk of active tuberculosis during pregnancy and postpartum: a register-based cohort study in Sweden","volume":"55","author":"J Jonsson","year":"2020","journal-title":"Eur Respir J"},{"key":"pone.0296993.ref003","first-page":"379271","article-title":"Tuberculosis in pregnancy: a review","volume":"2012","author":"OM Loto","year":"2012","journal-title":"J Pregnancy"},{"issue":"12","key":"pone.0296993.ref004","doi-asserted-by":"crossref","first-page":"e710","DOI":"10.1016\/S2214-109X(14)70330-4","article-title":"Tuberculosis in pregnancy: an estimate of the global burden of disease","volume":"2","author":"J Sugarman","year":"2014","journal-title":"Lancet Glob Health"},{"key":"pone.0296993.ref005","volume-title":"Module 2: screening\u2014systematic screening for tuberculosis disease","author":"World Health Organization","year":"2021"},{"key":"pone.0296993.ref006","unstructured":"World Health Organization. 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