HIV Testing among Patients with Presumptive Tuberculosis: How Do We Implement in a Routine Programmatic Setting? Results of a Large Operational Research from India.

Ajay Mv Kumar,Raghuram Rao,Suresh Shastri,Achuthan Sreenivas Nair,Deepak K Guddemane,R S Gupta,Puneet Dewan,Md Suryakanth,Devesh Gupta,Avinash Kanchar,Ashok Kumar,Anthony David Harries,Anthony David Harries,Devesh Gupta,Avinash Kanchar,Avinash Kanchar,Chethana Rangaraju,Balaji Naik,Prashant Bhat,Ashok Kumar,Raghuram Rao,Esaki M Shankar

doi:10.1371/journal.pone.0156487

Abstract

BackgroundIn March 2012, World Health Organization recommended that HIV testing should be offered to all patients with presumptive TB (previously called TB suspects). How this is best implemented and monitored in routine health care settings in India was not known. An operational research was conducted in Karnataka State (South India, population 64 million, accounts for 10% of India’s HIV burden), to test processes and learn results and challenges of screening presumptive TB patients for HIV within routine health care settings.MethodsIn this cross-sectional study conducted between January-March 2012, all presumptive TB patients attending public sector sputum microscopy centres state-wide were offered HIV testing by the laboratory technician, and referred to the nearest public sector HIV counselling and testing services, usually within the same facility. The HIV status of the patients was recorded in the routine TB laboratory form and TB laboratory register. The laboratory register was compiled to obtain the number of presumptive TB patients whose HIV status was ascertained, and the number found HIV positive. Aggregate data on reasons for non-testing were compiled at district level.ResultsOverall, 115,308 patients with presumptive TB were examined for sputum smear microscopy at 645 microscopy centres state-wide. Of these, HIV status was ascertained for 62,847(55%) among whom 7,559(12%) were HIV-positive, and of these, 3,034(40%) were newly diagnosed. Reasons for non-testing were reported for 37,700(72%) of the 52,461 patients without HIV testing; non-availability of testing services at site of sputum collection was cited by health staff in 54% of respondents. Only 4% of patients opted out of HIV testing.ConclusionOffering HIV testing routinely to presumptive TB patients detected large numbers of previously-undetected instances of HIV infection. Several operational challenges were noted which provide useful lessons for improving uptake of HIV testing in this important group.

Highlights

According to the World Health Organization (WHO) Global TB Report 2014, an estimated 1.1 million people globally had HIV-associated tuberculosis (TB), and 360,000 died from HIVassociated TB in 2013. [1] Three important reasons have been given for this unacceptably high death rate: i) in persons with HIV/AIDS, TB was not diagnosed and treated; ii) in patients with TB, HIV was not diagnosed and co-infected patients were not referred to HIV care and treatment; and iii) when the two diseases were diagnosed and treated, this often happened far too late to be effective.[2]In March 2012, WHO launched its updated policy on collaborative TB/HIV activities to reduce the burden of TB and HIV
115,308 patients with presumptive TB were examined for sputum smear microscopy at 645 microscopy centres state-wide
HIV status was ascertained for 62,847(55%) among whom 7,559(12%) were HIV-positive, and of these, 3,034(40%) were newly diagnosed

Summary

Introduction

According to the World Health Organization (WHO) Global TB Report 2014, an estimated 1.1 million people globally had HIV-associated tuberculosis (TB), and 360,000 died from HIVassociated TB in 2013. [1] Three important reasons have been given for this unacceptably high death rate: i) in persons with HIV/AIDS, TB was not diagnosed and treated; ii) in patients with TB, HIV was not diagnosed and co-infected patients were not referred to HIV care and treatment; and iii) when the two diseases were diagnosed and treated, this often happened far too late to be effective.[2]In March 2012, WHO launched its updated policy on collaborative TB/HIV activities to reduce the burden of TB and HIV. In March 2012, World Health Organization recommended that HIV testing should be offered to all patients with presumptive TB (previously called TB suspects). How this is best implemented and monitored in routine health care settings in India was not known. An operational research was conducted in Karnataka State (South India, population 64 million, accounts for 10% of India’s HIV burden), to test processes and learn results and challenges of screening presumptive TB patients for HIV within routine health care settings

Methods

Results

Conclusion