Abstract
IntroductionWhile HIV care among tuberculosis (TB) patients is successfully implemented and monitored, it is not routinely reported among “presumptive TB patients without TB”. The present study describes the ascertainment of HIV status and receipt of antiretroviral therapy (ART) and the associated factors among presumptive TB patients (with and without TB) in 35 public health facilities of Masvingo district of Zimbabwe from January to June 2017.MethodsThis was an analysis of secondary programme data. We performed log binomial regression to calculate adjusted relative risks (aRR) and 95% confidence intervals (CI).ResultsOf 1369 presumptive TB patients, 1181 (86%) were ascertained for HIV status (98% among those subsequently diagnosed with TB, 83% among non-TB). Of them, 748 (63%) were HIV positive, more among TB patients (69%) than those without TB (61%). Among HIV-positive patients, 475 (64%) received ART, significantly higher among TB patients (78%) compared to those without TB (57%). Patients without TB were significantly more likely to have non-ascertained for HIV status (aRR=2.4, 95% CI=1.4-5.0) and not receiving ART (aRR=1.8, 95% CI=1.6-2.0), compared to those with TB.ConclusionWe found high rates of HIV status ascertainment among presumptive TB patients. But, ART uptake was poor among “presumptive TB patients without TB”, despite implementation of “test and treat” strategy in Zimbabwe. The programme should step up the monitoring of HIV status and ART receipt among presumptive TB patients, by introducing an indicator in the quarterly reports of the national TB programme.
Highlights
Despite great progress in the response to Tuberculosis-Human Immunodeficiency Virus (TB/HIV) syndemic globally, the morbidity and mortality remains high
Several programmatic interventions have been implemented by the national HIV programme in Zimbabwe including decentralized availability of HIV testing and antiretroviral therapy (ART) services at all health facilities and the adoption of "test and treat" policy, meaning all PLHIV be started on ART irrespective of CD4 count or clinical staging [17]
The key findings of the study are: a) high rates of HIV status ascertainment among presumptive TB patients, which was better among TB patients compared to non-TB, b) two-thirds of those ascertained for HIV status were HIV positive, again marginally higher among TB patients c) poor ART uptake, worse among HIV patients without TB compared to HIV-TB co-infected patients
Summary
Despite great progress in the response to Tuberculosis-Human Immunodeficiency Virus (TB/HIV) syndemic globally, the morbidity and mortality remains high. Several programmatic interventions have been implemented by the national HIV programme in Zimbabwe including decentralized availability of HIV testing and ART services at all health facilities and the adoption of "test and treat" policy, meaning all PLHIV be started on ART irrespective of CD4 count or clinical staging [17]. Whether these measures have resulted in improved HIV care among presumptive TB patients is not known. The present study was carried out to describe the ascertainment of HIV status and uptake of ART services and the associated factors among presumptive TB patients (with and without TB) attending the public health facilities of Masvingo district, Zimbabwe during January-June 2017
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