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Completion of the tuberculosis care cascade in a community‐based HIV linkage‐to‐care study in South Africa and Uganda

INTRODUCTION: Tuberculosis (TB) is the leading cause of HIV‐associated mortality in Africa. As HIV testing, linkage to care and antiretroviral treatment initiation intensify to meet UNAIDS targets, it is not known what effect these efforts will have on TB detection and prevention. We aimed to charac...

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Autores principales: Shapiro, Adrienne E, van Heerden, Alastair, Schaafsma, Torin T, Hughes, James P, Baeten, Jared M, van Rooyen, Heidi, Tumwesigye, Elioda, Celum, Connie L, Barnabas, Ruanne V
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810338/
https://www.ncbi.nlm.nih.gov/pubmed/29381257
http://dx.doi.org/10.1002/jia2.25065
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author Shapiro, Adrienne E
van Heerden, Alastair
Schaafsma, Torin T
Hughes, James P
Baeten, Jared M
van Rooyen, Heidi
Tumwesigye, Elioda
Celum, Connie L
Barnabas, Ruanne V
author_facet Shapiro, Adrienne E
van Heerden, Alastair
Schaafsma, Torin T
Hughes, James P
Baeten, Jared M
van Rooyen, Heidi
Tumwesigye, Elioda
Celum, Connie L
Barnabas, Ruanne V
author_sort Shapiro, Adrienne E
collection PubMed
description INTRODUCTION: Tuberculosis (TB) is the leading cause of HIV‐associated mortality in Africa. As HIV testing, linkage to care and antiretroviral treatment initiation intensify to meet UNAIDS targets, it is not known what effect these efforts will have on TB detection and prevention. We aimed to characterize the TB care cascade of screening, diagnostic testing, treatment and provision of isoniazid preventive therapy (IPT) in a study of community‐based HIV screening and linkage to care and determine whether symptom screening results affected progress along the cascade. METHODS: Between June 2013 and March 2015, HIV‐infected adults enrolled in the Linkages study, a multi‐site, community‐based, randomized HIV screening and linkage‐to‐care study in South Africa and Uganda. All participants were screened for TB symptoms at entry after testing positive for HIV and referred to local clinics for care. During the 9 month follow‐up, participants were periodically surveyed about clinic linkage and initiation of HIV care as well as subsequent TB testing, treatment, or IPT. We compared outcomes between persons with and without a positive symptom screen at baseline using descriptive statistics and Poisson regression to calculate relative risks of outcomes along the care cascade. RESULTS AND DISCUSSION: Of the 1,325 HIV‐infected adults enrolled, 26% reported at least one TB symptom at the time of HIV diagnosis. Loss of appetite and fever were the most commonly reported symptoms on a TB symptom screen. Despite 92% HIV linkage success, corresponding TB linkage was incomplete. Baseline TB symptoms were associated with an increased risk of a TB diagnosis (relative risk 3.23, 95% CI 1.51 to 6.91), but only 34% of symptomatic persons had sputum TB testing. Fifty‐five percent of participants diagnosed with TB started TB treatment. In South Africa, only 18% of asymptomatic participants initiated IPT after linkage to HIV care, and presence of symptoms was not associated with IPT initiation (relative risk 0.86 95% CI 0.6 to 1.23). CONCLUSIONS: HIV linkage to care interventions provide an opportunity to improve completion of the TB care cascade, but will require additional support to realize full benefits.
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spelling pubmed-58103382018-02-14 Completion of the tuberculosis care cascade in a community‐based HIV linkage‐to‐care study in South Africa and Uganda Shapiro, Adrienne E van Heerden, Alastair Schaafsma, Torin T Hughes, James P Baeten, Jared M van Rooyen, Heidi Tumwesigye, Elioda Celum, Connie L Barnabas, Ruanne V J Int AIDS Soc Short Reports INTRODUCTION: Tuberculosis (TB) is the leading cause of HIV‐associated mortality in Africa. As HIV testing, linkage to care and antiretroviral treatment initiation intensify to meet UNAIDS targets, it is not known what effect these efforts will have on TB detection and prevention. We aimed to characterize the TB care cascade of screening, diagnostic testing, treatment and provision of isoniazid preventive therapy (IPT) in a study of community‐based HIV screening and linkage to care and determine whether symptom screening results affected progress along the cascade. METHODS: Between June 2013 and March 2015, HIV‐infected adults enrolled in the Linkages study, a multi‐site, community‐based, randomized HIV screening and linkage‐to‐care study in South Africa and Uganda. All participants were screened for TB symptoms at entry after testing positive for HIV and referred to local clinics for care. During the 9 month follow‐up, participants were periodically surveyed about clinic linkage and initiation of HIV care as well as subsequent TB testing, treatment, or IPT. We compared outcomes between persons with and without a positive symptom screen at baseline using descriptive statistics and Poisson regression to calculate relative risks of outcomes along the care cascade. RESULTS AND DISCUSSION: Of the 1,325 HIV‐infected adults enrolled, 26% reported at least one TB symptom at the time of HIV diagnosis. Loss of appetite and fever were the most commonly reported symptoms on a TB symptom screen. Despite 92% HIV linkage success, corresponding TB linkage was incomplete. Baseline TB symptoms were associated with an increased risk of a TB diagnosis (relative risk 3.23, 95% CI 1.51 to 6.91), but only 34% of symptomatic persons had sputum TB testing. Fifty‐five percent of participants diagnosed with TB started TB treatment. In South Africa, only 18% of asymptomatic participants initiated IPT after linkage to HIV care, and presence of symptoms was not associated with IPT initiation (relative risk 0.86 95% CI 0.6 to 1.23). CONCLUSIONS: HIV linkage to care interventions provide an opportunity to improve completion of the TB care cascade, but will require additional support to realize full benefits. John Wiley and Sons Inc. 2018-01-30 /pmc/articles/PMC5810338/ /pubmed/29381257 http://dx.doi.org/10.1002/jia2.25065 Text en © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society. This is an open access article under the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Short Reports
Shapiro, Adrienne E
van Heerden, Alastair
Schaafsma, Torin T
Hughes, James P
Baeten, Jared M
van Rooyen, Heidi
Tumwesigye, Elioda
Celum, Connie L
Barnabas, Ruanne V
Completion of the tuberculosis care cascade in a community‐based HIV linkage‐to‐care study in South Africa and Uganda
title Completion of the tuberculosis care cascade in a community‐based HIV linkage‐to‐care study in South Africa and Uganda
title_full Completion of the tuberculosis care cascade in a community‐based HIV linkage‐to‐care study in South Africa and Uganda
title_fullStr Completion of the tuberculosis care cascade in a community‐based HIV linkage‐to‐care study in South Africa and Uganda
title_full_unstemmed Completion of the tuberculosis care cascade in a community‐based HIV linkage‐to‐care study in South Africa and Uganda
title_short Completion of the tuberculosis care cascade in a community‐based HIV linkage‐to‐care study in South Africa and Uganda
title_sort completion of the tuberculosis care cascade in a community‐based hiv linkage‐to‐care study in south africa and uganda
topic Short Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810338/
https://www.ncbi.nlm.nih.gov/pubmed/29381257
http://dx.doi.org/10.1002/jia2.25065
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