Feasibility of Provider-Initiated HIV Testing and Counselling of Tuberculosis Patients Under the TB Control Programme in Two Districts of South IndiaReport as inadecuate




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Background

Provider-initiated HIV testing and counselling PITC is internationally recommended for tuberculosis TB patients, but the feasibility, effectiveness, and impact of this policy on the TB programme in India are unknown. We evaluated PITC of TB patients across two districts in India considered to have generalized HIV epidemics, Tiruchirappalli population 2.5 million and Mysore population 2.8 million.

Methodology-Principal Findings

Starting June 2007, healthcare providers in both districts were instructed to ascertain HIV status for all TB patients, and refer those with unknown HIV status to the nearest Integrated Counselling and Testing Centre ICTC—often in the same facility—for counselling and voluntary HIV testing. All TB patients registered from June 2007 to March 2008 were followed prospectively. Field investigators assessed PITC practices and abstracted data from routine TB programme records and HIV counselling registers to determine the proportion of TB patients appropriately evaluated for HIV infection. Patient records were traced to determine the efficiency of referral links to HIV care and antiretroviral treatment ART. Between July 2007 and March 2008, 5299 TB patients were registered in both study districts. Of the 4701 with unknown HIV status at the time of TB treatment initiation, 3368 72% were referred to an ICTC, and 3111 66% were newly tested for HIV. PITC implementation resulted in the ascertainment of HIV status for 3709-5299 70% of TB patients, and detected 200 cases with previously undiagnosed HIV infection. Overall, 468 8.8% of all registered TB patients were HIV-infected; 177 37% were documented to have also received any ART.

Conclusions

With implementation of PITC in India, HIV status was successfully ascertained for 70% of TB patients. Previously undiagnosed HIV-infection was detected in 6.4% of those TB patients newly tested, enabling referral for life-saving anti-retroviral treatment. ART uptake, however, was poor, suggesting that PITC implementation should include measures to strengthen and support ART referral, evaluation, and initiation.



Author: Sophia Vijay , Soumya Swaminathan, Preetish Vaidyanathan, Aleyamma Thomas, L. S. Chauhan, Prahlad Kumar, Sonali Chiddarwar, Beena

Source: http://plos.srce.hr/



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