Pulmonary tuberculosis diagnostic practices among people living with the human immunodeficiency virus in Lesotho

• Published in: The international journal of tuberculosis and lung disease 2017-10, Vol.21 (10), p.1133-1138
• Main Authors: O'Connor, D. E., Frederix, K., Saito, S., Maama, L. B., Hirsch-Moverman, Y., Pitt, B., Hayes-Larson, E., Lebelo, L., Shale, M., Howard, A. A.
• Format: Article
• Language: English
• Subjects: Adult; Anti-HIV Agents - administration & dosage; Antiretroviral agents; Antiretroviral therapy; Antitubercular Agents - administration & dosage; Design standards; Diagnosis; Diagnostic systems; Female; Health care facilities; HIV; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Implementation Science; Lesotho - epidemiology; Male; Middle Aged; Patients; Tb Diagnosis; TB-HIV integration; Time Factors; Tuberculosis; Tuberculosis, Pulmonary - diagnosis; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - epidemiology; Viruses
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.17.0297

SETTING: Twelve health facilities in Berea District, Lesotho, that participated in the Start TB Patients on ART and Retain on Treatment (START) Study, a mixed-methods cluster-randomized trial evaluating a combination intervention package to improve early initiation of antiretroviral therapy (ART) and anti-tuberculosis treatment success among patients with tuberculosis (TB) and human immunodeficiency virus (HIV).OBJECTIVE: To assess TB and HIV diagnostic practices among TB-HIV patients.DESIGN: A standardized survey assessed services at each facility at baseline. Routine clinical data were abstracted for all newly registered adult TB-HIV patients during the study period. Descriptive statistics were used to assess TB diagnostic practices, timing of the HIV diagnosis, and ART status at TB treatment initiation.RESULTS: Between April 2013 and March 2015, 1233 TB-HIV patients were enrolled. Among 1215 patients with available data, 87.2% had pulmonary TB, of which 34.8% were bacteriologically confirmed, 40.9% tested negative and 24.3% were not tested. Among 1138 patients with available data, 53.3% had an existing HIV diagnosis, of whom 39.3% were ART-naïve.CONCLUSIONS: The majority of pulmonary TB patients were clinically diagnosed, and many were unaware of their HIV status or were ART-naïve despite known status. The Test and Treat Strategy holds promise to prevent TB and reduce TB-related mortality among people living with HIV; however, enhanced TB diagnostic capacity and improved HIV case detection are urgently needed.