D E O'Connor1, K Frederix2, S Saito3, L B Maama4, Y Hirsch-Moverman3, B Pitt2, E Hayes-Larson3, L Lebelo2, M Shale2, A A Howard3. 1. ICAP at Columbia University, Mailman School of Public Health, New York, New York, College of Physicians and Surgeons, Columbia University, New York, New York, USA. 2. ICAP at Columbia University, Maseru, Lesotho. 3. ICAP at Columbia University, Mailman School of Public Health, New York, New York, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA. 4. National Tuberculosis Program, Lesotho Ministry of Health, Maseru, Lesotho.
Abstract
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 acombination 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% hadpulmonary 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.
RCT Entities:
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-HIVpatients. DESIGN: A standardized survey assessed services at each facility at baseline. Routine clinical data were abstracted for all newly registered adult TB-HIVpatients 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-HIVpatients 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 TBpatients 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.
Authors: Beatriz Grinsztejn; Mina C Hosseinipour; Heather J Ribaudo; Susan Swindells; Joseph Eron; Ying Q Chen; Lei Wang; San-San Ou; Maija Anderson; Marybeth McCauley; Theresa Gamble; Nagalingeshwaran Kumarasamy; James G Hakim; Johnstone Kumwenda; Jose H S Pilotto; Sheela V Godbole; Suwat Chariyalertsak; Marineide Gonçalves de Melo; Kenneth H Mayer; Susan H Eshleman; Estelle Piwowar-Manning; Joseph Makhema; Lisa A Mills; Ravindre Panchia; Ian Sanne; Joel Gallant; Irving Hoffman; Taha E Taha; Karin Nielsen-Saines; David Celentano; Max Essex; Diane Havlir; Myron S Cohen Journal: Lancet Infect Dis Date: 2014-03-04 Impact factor: 25.071
Authors: Jens D Lundgren; Abdel G Babiker; Fred Gordin; Sean Emery; Birgit Grund; Shweta Sharma; Anchalee Avihingsanon; David A Cooper; Gerd Fätkenheuer; Josep M Llibre; Jean-Michel Molina; Paula Munderi; Mauro Schechter; Robin Wood; Karin L Klingman; Simon Collins; H Clifford Lane; Andrew N Phillips; James D Neaton Journal: N Engl J Med Date: 2015-07-20 Impact factor: 91.245
Authors: Karen R Steingart; Hojoon Sohn; Ian Schiller; Lorie A Kloda; Catharina C Boehme; Madhukar Pai; Nandini Dendukuri Journal: Cochrane Database Syst Rev Date: 2013-01-31