Feasibility and Effectiveness of Provider Initiated HIV Testing and Counseling of TB Suspects in Vizianagaram District, South India

Shanta Achanta,Srinivas Rao Motta Shamrao,Rama Rao Tekumalla,Ramakrishna Uppaluri,Puneet K Dewan,Ashok Kumar,Devesh Gupta,Sharath Burugina Nagaraja,Srinath Satyanarayana,Ajay M V Kumar,Jyoti Jaju,Madhukar Pai

doi:10.1371/journal.pone.0041378

Abstract

BackgroundThough internationally recommended, provider initiated HIV testing and counseling (PITC) of persons suspected of tuberculosis (TB) is not a policy in India; HIV seroprevalence among TB suspects has never been reported. The current policy of PITC for diagnosed TB cases may limit opportunities of early HIV diagnosis and treatment. We determined HIV seroprevalence among persons suspected of TB and assessed feasibility and effectiveness of PITC implementation at this earlier stage in the TB diagnostic pathway.MethodsAll adults examined for diagnostic sputum microscopy (TB suspects) in Vizianagaram district (population 2.5 million), in November-December 2010, were offered voluntary HIV counseling and testing (VCT) and assessed for TB diagnosis.ResultsOf 2918 eligible TB suspects, 2465(85%) consented to VCT. Among these, 246(10%) were HIV-positive. Of the 246, 84(34%) were newly diagnosed as HIV (HIV status not known previously). To detect a new case of HIV infection, the number needed to screen (NNS) was 26 among ‘TB suspects’, comparable to that among ‘TB patients’. Among suspects aged 25–54 years, not diagnosed as TB, the NNS was 17.ConclusionThe seroprevalence of HIV among ‘TB suspects’ was as high as that among ‘TB patients’. Implementation of PITC among TB suspects was feasible and effective, detecting a large number of new HIV cases with minimal additional workload on staff of HIV testing centre. HIV testing of TB suspects aged 25–54 years demonstrated higher yield for a given effort, and should be considered by policy makers at least in settings with high HIV prevalence.

Highlights

According to World Health Organization’s (WHO) global TB report 2010, Tuberculosis (TB) accounted for 25% of all deaths among people living with HIV/AIDS (PLHIV) in 2009 [1]
The recommendation of provider initiated HIV testing and counseling (PITC) for all TB suspects is based on study findings from sub-Saharan African countries, which have shown a very high HIV prevalence among persons being evaluated for TB (TB suspects), sometimes even higher than HIV prevalence among TB patients [3,4]
Those who are diagnosed as TB patients are treated with fully intermittent short course chemotherapy administered under direct observation (DOT) and registered in one of the six programme management units as per national guidelines [9]

Summary

Introduction

According to World Health Organization’s (WHO) global TB report 2010, Tuberculosis (TB) accounted for 25% of all deaths among people living with HIV/AIDS (PLHIV) in 2009 [1]. The recommendation of PITC for all TB suspects is based on study findings from sub-Saharan African countries, which have shown a very high HIV prevalence among persons being evaluated for TB (TB suspects), sometimes even higher than HIV prevalence among TB patients [3,4]. These findings from HIV endemic settings cannot, be generalized to lower HIV burden settings such as India. Provider initiated HIV testing and counseling (PITC) of persons suspected of tuberculosis (TB) is not a policy in India; HIV seroprevalence among TB suspects has never been reported. We determined HIV seroprevalence among persons suspected of TB and assessed feasibility and effectiveness of PITC implementation at this earlier stage in the TB diagnostic pathway

Methods

Results

Discussion

Conclusion