Using tuberculosis suspects to identify patients eligible for antiretroviral treatment

A district in rural sub-Saharan Africa with a recently introduced antiretroviral (ARV) programme. The population has high human immunodeficiency virus (HIV) prevalence and high tuberculosis (TB) incidence.

To determine the prevalence of HIV and acquired immune-deficiency syndrome (AIDS) related symptoms in people presenting with chronic cough who are not diagnosed with TB.

A cross-sectional survey of TB suspects.

Patients with chronic cough were recruited from out-patient facilities. After standard diagnostic procedures and providing informed consent, they received counselling and testing for HIV, and were interviewed and examined with respect to staging criteria for HIV/AIDS. Suspects were followed up for 3 months after the end of the recruitment period to allow for delayed diagnosis of TB.

Of 145 suspects, 79% had not been diagnosed with TB by the end of the follow-up period. Of these, 108 (95%) agreed to HIV testing and 61 (56%) were HIV-positive. More than half of these were eligible for ARV treatment (Stage III or IV disease) under national programme criteria.

Established chronic cough clinics are a useful setting for recruitment of patients to ARV clinics. Attendees should be offered HIV testing and simple clinical screening to identify those who should be referred for ARV treatment.