Stis/hiv and hiv/tb interventions for prevention and control of syndemics in resource-constrained settings

Resumen

This thesis research is about the burden of co-occurring epidemics affecting resource-constrained settings and the forces driving them into and excess burden of disease morbidity and mortality. This thesis presents and discusses models to effectively deliver health care according to the needs of the populations studied and the availability of resources. This thesis is organized as a compendium of 4 published papers and 2 manuscripts submitted for publication related to human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) and to HIV and tuberculosis (TB). There are 2 differentiated parts: the STIs/HIV part and the HIV/TB part with HIV infection as a connection for both parts. The 2 publications for the STIs/HIV part arise from field work studies in Guatemala in 2012; the 2 publications and 2 submitted manuscripts for the HIV/TB part arise from data from Malawi, and the field work performed in Guatemala during 2013-2015 and Mozambique during 2017-2019. The first part of the thesis analyses STIs/HIV care in Guatemala during 2005-2012 and the effectiveness of integrated, community-based STIs/HIV joint interventions to decrease prevalence trends in STIs/HIV in key populations. The importance of integrated STIs/HIV biological and behavioural surveillance for clinical management and programmatic health care performance is also discussed. Finally, it is emphasized the need of accurate data to inform and guide public health policies and interventions to effectively allocate resources for prevention and control strategies. The second part of this thesis evaluates recommended TB/HIV collaborative activities and interventions. One line of research is the assessment of current models of TB/HIV services integration using TB incidence and mortality outcomes in people living with HIV (PLHIV). The other line of research is one of the 3“I’s” of the World Health Organization’s (WHO) 3 “I’s” strategy, that is, intensified TB case finding; two diagnostic tests for TB screening in PLHIV are presented as well as discussion about their risks and benefits to be implemented as point-of-care (POC) tests in health care centres in resource-constrained settings. Only 3 of the published papers fulfil the requirements to be presented as a compendium of publications in this thesis research.