Abstract
BackgroundProvider-initiated HIV testing and counselling (PITC) is internationally recommended for tuberculosis (TB) patients, but the feasibility, effectiveness, and impact of this policy on the TB programme in India are unknown. We evaluated PITC of TB patients across two districts in India considered to have generalized HIV epidemics, Tiruchirappalli (population 2.5 million) and Mysore (population 2.8 million).Methodology/Principal FindingsStarting June 2007, healthcare providers in both districts were instructed to ascertain HIV status for all TB patients, and refer those with unknown HIV status to the nearest Integrated Counselling and Testing Centre (ICTC)—often in the same facility—for counselling and voluntary HIV testing. All TB patients registered from June 2007 to March 2008 were followed prospectively. Field investigators assessed PITC practices and abstracted data from routine TB programme records and HIV counselling registers to determine the proportion of TB patients appropriately evaluated for HIV infection. Patient records were traced to determine the efficiency of referral links to HIV care and antiretroviral treatment (ART). Between July 2007 and March 2008, 5299 TB patients were registered in both study districts. Of the 4701 with unknown HIV status at the time of TB treatment initiation, 3368 (72%) were referred to an ICTC, and 3111 (66%) were newly tested for HIV. PITC implementation resulted in the ascertainment of HIV status for 3709/5299 (70%) of TB patients, and detected 200 cases with previously undiagnosed HIV infection. Overall, 468 (8.8%) of all registered TB patients were HIV-infected; 177 (37%) were documented to have also received any ART.ConclusionsWith implementation of PITC in India, HIV status was successfully ascertained for 70% of TB patients. Previously undiagnosed HIV-infection was detected in 6.4% of those TB patients newly tested, enabling referral for life-saving anti-retroviral treatment. ART uptake, however, was poor, suggesting that PITC implementation should include measures to strengthen and support ART referral, evaluation, and initiation.
Highlights
The HIV/AIDS epidemic has increased the global tuberculosis (TB) burden, and has focused attention on the necessity to closely coordinate TB and HIV/AIDS control programme services [1]
To guide TB-HIV policy in India, we prospectively evaluated the implementation of Provider-initiated HIV testing and counselling (PITC) in the programme for all tuberculosis patients registered in two districts in south India
Among the remaining 4,701 TB patients with unknown HIV status, 3,368 (71.6%) were referred for HIV testing. Among those referred for HIV testing, the median interval from the starting of TB treatment to referral for testing was 8 days (25%–75% interquartile range 0–28 days)
Summary
The HIV/AIDS epidemic has increased the global tuberculosis (TB) burden, and has focused attention on the necessity to closely coordinate TB and HIV/AIDS control programme services [1]. As of 2007, the policy of the Government of India’s Revised National Tuberculosis Control Programme (RNTCP) and the National AIDS Control Organization (NACO) was to offer referral for HIV testing only to those patients with behavioural risk factors for HIV infection or evidence of opportunistic infections [6]. This approach proved to be operationally challenging, as routine ascertainment of HIV behavioural risk factors in patients or their partners was not always possible due to crowded outpatient clinical services. We evaluated PITC of TB patients across two districts in India considered to have generalized HIV epidemics, Tiruchirappalli (population 2.5 million) and Mysore (population 2.8 million)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
