Abstract
Background: HIV-negative men are over-represented in tuberculosis (TB) prevalence surveys including the first South African national TB prevalence survey in 2018. Traditionally, TB screening is focused in clinics. We aimed to determine the frequency of primary healthcare clinic (PHC) attendance among HIV-negative men in a TB-prevalent setting. Methods: Since January 2017, PHC attendees in a rural South African demographic surveillance area (DSA) were asked their reason for attendance. HIV status was defined as positive if tested positive in a DSA sero-survey or attended clinic for HIV care; negative if tested negative between January 2014—December 2017 and no HIV-related visits; and HIV-unknown otherwise. Results: Among 67124 DSA residents (≥15 years), 27038 (40.3%) were men; 14196 (21.2%) were classified HIV-positive, 18892 (28.1%) HIV-negative and 34036 (50.7%) HIV-unknown. Between April 2017 and March 2018, 24382/67124 (36.3%, 95% confidence interval [CI] 36.0–36.7) adults made ≥1 PHC visit, comprising 9805/40086 (24.5%, 95%CI 23.6–25.3) of HIV-negative or unknown women and 3440/27038 (12.7%, 95%CI 11.6–13.8) of HIV-negative or unknown men. Overall, HIV care accounted for 37556/88109 (42.6%) of adult PHC visits. Conclusion: In this rural population, HIV-negative and -unknown men rarely attend PHCs. Improving TB screening in clinics may not reach a key population with respect to undiagnosed TB. Additional strategies are needed to diagnose and treat TB earlier.
Highlights
Based on data from 2013, South Africa was estimated to have 160000 “missing” people with tuberculosis (TB), that is individuals with active TB disease who were not on treatment[1], who may contribute to continuing transmission
Improving TB screening in clinics may not reach a key population with respect to undiagnosed TB
This article is included in the Africa Health Research Institute (AHRI) gateway
Summary
Based on data from 2013, South Africa was estimated to have 160000 “missing” people with tuberculosis (TB), that is individuals with active TB disease who were not on treatment[1], who may contribute to continuing transmission. The World Health Organization (WHO) has traditionally recommended active case finding for TB among individuals attending health facilities[2] This approach will only reduce transmission if people with undiagnosed, infectious TB are identified at health facilities and start appropriate treatment early, and reduce their duration of infectiousness. This is a concern for men, who are generally perceived to attend health care facilities less often than women[3,4]. In Zambia and Kenya (where the prevalence surveys offered HIV testing as well as TB screening) over 80% people with undiagnosed active TB were HIV-negative or HIV-unknown. Results: Among 67124 DSA residents (≥15 years), 27038 (40.3%) were men; 14196 (21.2%) were classified HIV-positive, 18892 (28.1%) HIV-
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