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Kyaw KWY, Kyaw NTT, Kyi MS, Aye S, Harries AD, Kumar AMV, Oo NL, Satyanarayana S, Aung ST. HIV testing uptake and HIV positivity among presumptive tuberculosis patients in Mandalay, Myanmar, 2014-2017. PLoS One 2020; 15:e0234429. [PMID: 32555731 PMCID: PMC7302489 DOI: 10.1371/journal.pone.0234429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/25/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction The World Health Organization’s framework for TB/HIV collaborative activities recommends provider-initiated HIV testing and counselling (PITC) of patients with presumptive TB. In Myanmar, PITC among presumptive TB patients was started at the TB outpatient department (TB OPD) in Mandalay in 2014. In this study, we assessed the uptake of PITC among presumptive TB patients and the number needed to screen to find one additional HIV positive case, stratified by demographic and clinical characteristics. Method This was a cross-sectional study using routinely collected data of presumptive TB patients who registered for PITC services at the TB OPD between August 2014 and December 2017 in Mandalay. Result Among 21,989 presumptive TB patients registered, 9,796 (44.5%) had known HIV status at registration and 2,763 (28.2%) were people already living with HIV (PLHIV). Of the remainder, 85.3% (10,401/12,193) were newly tested for HIV. Patients <55 years old, those registered in 2014, 2015 and 2017, those employed and those having a history of TB contact had higher uptakes of HIV testing. Among 10,401 patients tested for HIV, 213 (2.1%) patients were newly diagnosed with HIV and this included 147 (69.0%) who were not diagnosed as having TB. The overall prevalence of HIV (previously known and newly diagnosed) among presumptive TB patients was 14.8% (2,976/20,119). The number needed to screen to find one additional HIV case was 48: this number was lower (i.e., a higher yield) among patients aged 35–44 years and among those who were divorced or separated. Conclusion Uptake of HIV testing among eligible presumptive TB patients was high with four out of five presumptive TB patients being tested for HIV. This strategy detected many additional HIV-positive persons, and this included those who were not diagnosed with TB. We strongly recommend that this strategy be implemented nationwide in Myanmar.
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Affiliation(s)
- Khine Wut Yee Kyaw
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- * E-mail:
| | - Nang Thu Thu Kyaw
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Myo Su Kyi
- Department of Public Health, National Tuberculosis Programme, Myanmar
| | - Sandar Aye
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Anthony D. Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- London School of Hygiene and Tropical Medicine, London, England, United Kingdom
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Office, New Delhi, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India
| | - Nay Lynn Oo
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Si Thu Aung
- Disease Control Division, Department of Public Health, Nay Pyi Taw, Myanmar
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Ndudzo C, Tripathy JP, Tauro F, Sibanda C, Chiramba M, Shamu A, Masinire K, Muchengwa T, Kumar AM. HIV care among patients with presumptive tuberculosis in Masvingo district of Zimbabwe, 2017: how well are we doing? Pan Afr Med J 2019; 33:158. [PMID: 31565120 PMCID: PMC6756799 DOI: 10.11604/pamj.2019.33.158.15847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 02/25/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION While 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. METHODS This was an analysis of secondary programme data. We performed log binomial regression to calculate adjusted relative risks (aRR) and 95% confidence intervals (CI). RESULTS Of 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. CONCLUSION We 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.
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Affiliation(s)
| | - Jaya Prasad Tripathy
- The Union South-East Asia Office, International Union Against Tuberculosis and Lung Disease, New Delhi, India
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | | | | | | | | | | | | | - Ajay Mv Kumar
- The Union South-East Asia Office, International Union Against Tuberculosis and Lung Disease, New Delhi, India
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India
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Nliwasa M, MacPherson P, Gupta‐Wright A, Mwapasa M, Horton K, Odland JØ, Flach C, Corbett EL. High HIV and active tuberculosis prevalence and increased mortality risk in adults with symptoms of TB: a systematic review and meta-analyses. J Int AIDS Soc 2018; 21:e25162. [PMID: 30063287 PMCID: PMC6067081 DOI: 10.1002/jia2.25162] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/21/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION HIV and tuberculosis (TB) remain leading causes of preventable death in low- and middle-income countries (LMICs). The World Health Organization (WHO) recommends HIV testing for all individuals with TB symptoms, but implementation has been suboptimal. We conducted a systematic literature review and meta-analyses to estimate HIV and TB prevalence, and short-term (two to six months) mortality, among adults with TB symptoms at community- and facility level. METHODS We searched Embase, Global Health and MEDLINE databases, and reviewed conference abstracts for studies reporting simultaneous HIV and TB screening of adults in LMICs published between January 2003 and December 2017. Meta-analyses were performed to estimate prevalence of HIV, undiagnosed TB and mortality risk at different health system levels. RESULTS Sixty-two studies including 260,792 symptomatic adults were identified, mostly from Africa and Asia. Median HIV prevalence was 19.2% (IQR: 8.3% to 40.4%) at community level, 55.7% (IQR: 20.9% to 71.2%) at primary care level and 80.7% (IQR: 73.8% to 84.6%) at hospital level. Median TB prevalence was 6.9% (IQR: 3.3% to 8.4%) at community, 20.5% (IQR: 11.7% to 46.4%) at primary care and 36.4% (IQR: 22.9% to 40.9%) at hospital level. Median short-term mortality was 22.6% (IQR: 15.6% to 27.7%) among inpatients, 3.1% (IQR: 1.2% to 4.2%) at primary care and 1.6% (95% CI: 0.45 to 4.13, n = 1 study) at community level. CONCLUSIONS Adults with TB symptoms have extremely high prevalence of HIV infection, even when identified through community surveys. TB prevalence and mortality increased substantially at primary care and inpatient level respectively. Strategies to expand symptom-based TB screening combined with HIV and TB testing for all symptomatic individuals should be of the highest priority for both disease programmes in LMICs with generalized HIV epidemics. Interventions to reduce short-term mortality are urgently needed.
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Affiliation(s)
- Marriott Nliwasa
- Helse Nord Tuberculosis InitiativeDepartment of PathologyCollege of MedicineBlantyreMalawi
- Malawi‐Liverpool‐Welcome Trust Clinical Research ProgrammeBlantyreMalawi
- Clinical Research DepartmentLondon School of Hygiene & Tropical Medicine (LSHTM)LondonUK
| | - Peter MacPherson
- Department of Clinical SciencesLiverpool School of Tropical MedicineLiverpoolUK
| | - Ankur Gupta‐Wright
- Malawi‐Liverpool‐Welcome Trust Clinical Research ProgrammeBlantyreMalawi
- Clinical Research DepartmentLondon School of Hygiene & Tropical Medicine (LSHTM)LondonUK
| | - Mphatso Mwapasa
- Helse Nord Tuberculosis InitiativeDepartment of PathologyCollege of MedicineBlantyreMalawi
| | - Katherine Horton
- Clinical Research DepartmentLondon School of Hygiene & Tropical Medicine (LSHTM)LondonUK
| | - Jon Ø Odland
- Department of Community MedicineFaculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
- School of Public HealthUniversity of PretoriaPretoriaSouth Africa
| | - Clare Flach
- Department of Primary Care & Public Health SciencesKing's College LondonLondonUK
| | - Elizabeth L. Corbett
- Helse Nord Tuberculosis InitiativeDepartment of PathologyCollege of MedicineBlantyreMalawi
- Malawi‐Liverpool‐Welcome Trust Clinical Research ProgrammeBlantyreMalawi
- Clinical Research DepartmentLondon School of Hygiene & Tropical Medicine (LSHTM)LondonUK
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Ng'ambi W, Gugsa S, Tweya H, Girma B, Kanyerere H, Dambe I, Babaye Y, Mpunga J, Phiri S. Characteristics and management of presumptive tuberculosis in public health facilities in Malawi, 2014-2016. Public Health Action 2017; 7:282-288. [PMID: 29584793 PMCID: PMC5753781 DOI: 10.5588/pha.17.0050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/29/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Public health facilities providing tuberculosis (TB) and human immunodeficiency virus (HIV) services in Malawi. Objectives: Using routinely collected health service delivery data to describe trends in HIV ascertainment and use of the Xpert® MTB/RIF assay to diagnose TB among HIV-positive presumptive TB cases. Design: This was an implementation study of presumptive TB cases who sought care from 21 facilities between April 2014 and June 2016. Descriptive statistics were used to summarise patient, facility and service level characteristics. Results: Of 28 567 presumptive TB cases analysed, 23 198 (81%) had known HIV status. The proportion of ascertained HIV status in presumptive TB cases increased over the study period. HIV prevalence was 49%, with 73% of HIV-positive presumptive TB cases on antiretroviral therapy. Access to Xpert ranged between 37% and 63% per quarter among HIV-positive presumptive TB patients with smear-negative sputum results. Of 7829 patients with documented Xpert results, 68% were HIV-positive. Conclusion: After the introduction of registers with HIV-related variables, HIV ascertainment among presumptive TB cases increased over time. Access to Xpert was suboptimal among HIV-positive presumptive TB cases. Further collaboration between national TB and HIV programmes may facilitate increased use of Xpert for HIV-positive patients with presumptive TB who seek care in public health facilities.
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Affiliation(s)
- W Ng'ambi
- International Training and Education Center for Health (I-TECH), Lilongwe, Malawi
- Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
| | - S Gugsa
- Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
- I-TECH, Seattle, Washington, USA
| | - H Tweya
- Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - B Girma
- International Training and Education Center for Health (I-TECH), Lilongwe, Malawi
- National Tuberculosis Control Programme, Lilongwe, Malawi
| | - H Kanyerere
- National Tuberculosis Control Programme, Lilongwe, Malawi
| | - I Dambe
- National Tuberculosis Control Programme, Lilongwe, Malawi
| | - Y Babaye
- International Training and Education Center for Health (I-TECH), Lilongwe, Malawi
| | - J Mpunga
- National Tuberculosis Control Programme, Lilongwe, Malawi
| | - S Phiri
- Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Public Health, College of Medicine, School of Public Health and Family Medicine, University of Malawi, Blantyre, Malawi
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Ncube RT, Takarinda KC, Zishiri C, van den Boogaard W, Mlilo N, Chiteve C, Siziba N, Trinchán F, Sandy C. Age-stratified tuberculosis treatment outcomes in Zimbabwe: are we paying attention to the most vulnerable? Public Health Action 2017; 7:212-217. [PMID: 29201656 DOI: 10.5588/pha.17.0024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/24/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: A high tuberculosis (TB) incidence, resource-limited urban setting in Zimbabwe. Objectives: To compare treatment outcomes among people initiated on first-line anti-tuberculosis treatment in relation to age and other explanatory factors. Design: This was a retrospective record review of routine programme data. Results: Of 2209 patients included in the study, 133 (6%) were children (aged <10 years), 132 (6%) adolescents (10-19 years), 1782 (81%) adults (20-59 years) and 162 (7%) were aged ⩾60 years, defined as elderly. The highest proportion of smear-negative pulmonary TB cases was among the elderly (40%). Unfavourable outcomes, mainly deaths, increased proportionately with age, and were highest among the elderly (adjusted relative risk 3.8, 95%CI 1.3-10.7). Having previous TB, being human immunodeficiency virus positive and not on antiretroviral treatment or cotrimoxazole preventive therapy were associated with an increased risk of unfavourable outcomes. Conclusion: The elderly had the worst outcomes among all the age groups. This may be related to immunosuppressant comorbidities or other age-related diseases mis-classified as TB, as a significant proportion were smear-negative. Older persons need better adapted TB management and more sensitive diagnostic tools, such as Xpert® MTB/RIF.
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Affiliation(s)
- R T Ncube
- International Union Against Tuberculosis and Lung Disease (The Union), Zimbabwe Country Office, Harare, Zimbabwe
| | - K C Takarinda
- Centre for Operations Research, The Union, Paris, France.,AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - C Zishiri
- International Union Against Tuberculosis and Lung Disease (The Union), Zimbabwe Country Office, Harare, Zimbabwe
| | - W van den Boogaard
- Operational Research Unit, Médecins Sans Frontières, Luxembourg City, Luxembourg
| | - N Mlilo
- International Union Against Tuberculosis and Lung Disease (The Union), Zimbabwe Country Office, Harare, Zimbabwe
| | - C Chiteve
- International Union Against Tuberculosis and Lung Disease (The Union), Zimbabwe Country Office, Harare, Zimbabwe
| | - N Siziba
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - F Trinchán
- Bulawayo City Health Department, Bulawayo, Zimbabwe
| | - C Sandy
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
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Kumar AMV, Gupta D, Kumar A, Gupta RS, Kanchar A, Rao R, Shastri S, Suryakanth MD, Rangaraju C, Naik B, Guddemane DK, Bhat P, Nair AS, Harries AD, Dewan P. HIV Testing among Patients with Presumptive Tuberculosis: How Do We Implement in a Routine Programmatic Setting? Results of a Large Operational Research from India. PLoS One 2016; 11:e0156487. [PMID: 27244055 PMCID: PMC4887014 DOI: 10.1371/journal.pone.0156487] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 05/16/2016] [Indexed: 12/03/2022] Open
Abstract
Background 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 In 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. Results Overall, 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. Conclusion Offering 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.
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Affiliation(s)
- Ajay MV Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
- * E-mail:
| | - Devesh Gupta
- Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Ashok Kumar
- Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
- National AIDS Control Organization, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - R. S. Gupta
- Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
- National AIDS Control Organization, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Avinash Kanchar
- National AIDS Control Organization, Ministry of Health and Family Welfare, Government of India, New Delhi, India
- World Health Organization, Geneva, Switzerland
| | - Raghuram Rao
- National AIDS Control Organization, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Suresh Shastri
- State TB Cell, Directorate of Health Services, Bangalore, Karnataka, India
| | - MD Suryakanth
- State TB Cell, Directorate of Health Services, Bangalore, Karnataka, India
| | - Chethana Rangaraju
- Karnataka State AIDS prevention and control Society, Bangalore, Karnataka, India
| | - Balaji Naik
- World Health Organization Country Office for India, New Delhi, India
| | | | - Prashant Bhat
- World Health Organization Country Office for India, New Delhi, India
| | | | - Anthony David Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Puneet Dewan
- Bill & Melinda Gates Foundation, New Delhi, India
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