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

作者：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

来源：International Journal of Tuberculosis and Lung Disease, 2017, 21(10): 1133-1138.

DOI：10.5588/ijtld.17.0297

• TB-HIV integration
• implementation science
• TB diagnosis

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-naive.
CONCLUSIONS: The majority of pulmonary TB patients were clinically diagnosed, and many were unaware of their HIV status or were ART-naive 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.

• 出版日期2017-10