Abstract
Patients with tuberculosis (TB) symptoms have high prevalence of HIV, and should be prioritised for HIV testing. In a prospective cohort study in Bangwe primary care clinic, Blantyre, Malawi, all adults (18 years or older) presenting with an acute illness were screened for TB symptoms (cough, fever, night sweats, weight loss). Demographic characteristics were linked to exit interview by fingerprint bioidentification. Multivariable logistic regression models were constructed to estimate the proportion completing same-visit HIV testing, comparing between those with and without TB symptoms. There were 5427 adult attendees between 21/5/2018 and 6/9/2018. Exit interviews were performed for 2402 (44%). 276 patients were excluded from the analysis, being already on antiretroviral therapy (ART). Presentation with any TB symptom was common for men (54.6%) and women (57.4%). Overall 27.6% (585/ 2121) attenders reported being offered testing and 21.5% (455/2121) completed provider-initiated HIV testing and counselling (PITC) and received results. The proportions offered testing were similar among participants with and without TB symptoms (any TB symptom: 29.0% vs. 25.7%). This was consistent for each individual symptom; cough, weight loss, fever and night sweats. Multivariable regression models indicated men, younger adults and participants who had previously tested were more likely to complete PITC than women, older adults and those who had never previously tested. Same-visit completion of HIV testing was suboptimal, especially among groups known to have high prevalence of undiagnosed HIV. As countries approach universal coverage of ART, identifying and prioritising currently underserved groups for HIV testing will be essential.
Highlights
Patients with tuberculosis (TB) symptoms have high prevalence of HIV, and should be prioritised for HIV testing
Malawi is among the large proportion of countries still striving to reach these targets. Through initiatives such as provider-initiated testing and counselling (PITC), and with the strong support of the Malawi National HIV Programme, 70% of Malawians knew their status in 2016.[2]. Despite this being an improvement on previous years, there remains substantial room for further improvement
This study investigated PITC uptake for those with and without TB symptoms at a busy primary health care centre in Malawi
Summary
In a prospective cohort study in Bangwe primary care clinic, Blantyre, Malawi, all adults (18 years or older) presenting with an acute illness were screened for TB symptoms (cough, fever, night sweats, weight loss). Demographic characteristics were linked to exit interview by fingerprint bioidentification. Multivariable logistic regression models were constructed to estimate the proportion completing same-visit HIV testing, comparing between those with and without TB symptoms. We summarised characteristics of clinic attenders using proportions, medians and means, and compared them between those who did and did not undergo clinic exit interview. Individuals who reported cough of any duration, fever, weight loss, or night sweats were classified as having “any TB symptom”. Cough duration was recorded and in accordance with WHO guidelines, we defined chronic cough as self-reported cough lasting greater than two weeks
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