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

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dc.date.accessioned 2019-08-19T12:42:39Z
dc.date.available 2019-08-19T12:42:39Z
dc.date.issued 2019-01-29 en
dc.identifier.uri http://hdl.handle.net/20.500.11910/13288
dc.description.abstract 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. 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. 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). 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. en
dc.format.medium Print en
dc.subject HIV/AIDS en
dc.subject TUBERCULOSIS en
dc.subject UGANDA en
dc.subject COMMUNITY PARTICIPATION en
dc.title Completion of the tuberculosis care cascade in a community-based HIV linkage linkage-to-care study in South Africa and Uganda en
dc.type Journal Article en
dc.description.version Y en
dc.ProjectNumber N/A en
dc.Volume 21 en
dc.BudgetYear 2018/19 en
dc.ResearchGroup Human and Social Development en
dc.SourceTitle Journal of the International AIDS Society en
dc.ArchiveNumber 10699 en
dc.PageNumber Online en
dc.outputnumber 9718 en
dc.bibliographictitle Shapiro, A.E., Van Heerden, A., Schaafsma, T.T., Hughes, J.P., Baeten, J.M., Van Rooyen, H., Tumwesigye, E., Celum, C.L. & Barnabas, R.V. (2018) Completion of the tuberculosis care cascade in a community-based HIV linkage linkage-to-care study in South Africa and Uganda . <i>Journal of the International AIDS Society</i>. 21:Online. en
dc.publicationyear 2018 en
dc.contributor.author1 Shapiro, A.E. en
dc.contributor.author2 Van Heerden, A. en
dc.contributor.author3 Schaafsma, T.T. en
dc.contributor.author4 Hughes, J.P. en
dc.contributor.author5 Baeten, J.M. en
dc.contributor.author6 Van Rooyen, H. en
dc.contributor.author7 Tumwesigye, E. en
dc.contributor.author8 Celum, C.L. en
dc.contributor.author9 Barnabas, R.V. en


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