Household HIV Testing Uptake among Contacts of TB Patients in South Africa.

Kavindhran Velen,Salome Charalambous,Flora Popane,Gavin J Churchyard,Christopher J Hoffmann,Liesl Page-Shipp,James J Lewis

doi:10.1371/journal.pone.0155688

Abstract

BackgroundIn high HIV prevalence settings, offering HIV testing may be a reasonable part of contact tracing of index tuberculosis (TB) patients. We evaluated the uptake of HIV counselling and testing (HCT) among household contacts of index TB patients and the proportion of newly diagnosed HIV-infected persons linked into care as part of a household TB contact tracing study.MethodsWe recruited index TB patients at public health clinics in two South African provinces to obtain consent for household contact tracing. During scheduled household visits we offered TB symptom screening to all household members and HCT to individuals ≥14years of age. Factors associated with HCT uptake were investigated using a random effects logistic regression model.Results & DiscussionOut of 1,887 listed household members ≥14 years old, 984 (52%) were available during a household visit and offered HCT of which 108 (11%) self-reported being HIV infected and did not undergo HCT. Of the remaining 876, a total of 304 agreed to HCT (35%); 26 (8.6%) were newly diagnosed as HIV positive. In multivariable analysis, factors associated with uptake of HCT were prior testing (odds ratio 1.6; 95% confidence interval [CI]: 1.1–2.3) and another member in the household testing (odds ratio 2.4; 95% CI: 1.7–3.4). Within 3 months of testing HIV-positive, 35% reported initiating HIV care.ConclusionHCT as a component of household TB contact tracing reached individuals without prior HIV testing, however uptake of HIV testing was poor. Strategies to improve HIV testing in household contacts should be evaluated.

Highlights

Achieving maximum health and prevention benefits from antiretroviral therapy (ART) requires crossing a first threshold: diagnosis of HIV-infection
We evaluated the uptake of HIV counselling and testing (HCT) among household contacts of index TB patients and the proportion of newly diagnosed HIV-infected persons linked into care as part of a household TB contact tracing study
Factors associated with uptake of HCT were prior testing and another member in the household testing

Summary

Introduction

Achieving maximum health and prevention benefits from antiretroviral therapy (ART) requires crossing a first threshold: diagnosis of HIV-infection. In 2014 UNAIDS proposed the 90-90-90 target [1] proposing that by 2020 (1) 90% of all people living with HIV will know their status; (2) 90% of all people diagnosed HIV infection will receive sustained antiretroviral therapy (ART); and (3) 90% of all people receiving ART will have viral suppression. Despite impressive HIV counselling and testing (HCT) delivery in South Africa, 62% of HIVinfected men and 45% of HIV-infected women are unaware of their HIV status [3]. Efforts to achieve test and treat goals, reduce late presentation and associated morbidity, and achieve the UNAIDS 90-90-90 targets will require reaching more individuals earlier in the course of HIV infection. We evaluated the uptake of HIV counselling and testing (HCT) among household contacts of index TB patients and the proportion of newly diagnosed HIV-infected persons linked into care as part of a household TB contact tracing study

Results

Discussion

Conclusion