Provider-initiated diagnostic HIV counselling and testing in tuberculosis clinics in Thailand

Twelve large public hospitals geographically distributed in Thailand.

To assess the uptake of diagnostic human immunodeficiency virus (HIV) counselling and testing (DCT), HIV prevalence in tuberculosis (TB) patients and HIV services provided to newly diagnosed HIV-infected TB patients.

We provided DCT in TB clinics to newly registered TB patients. Post-test counselling was provided at TB clinics for non-HIV-infected patients and at HIV voluntary counselling and testing centres for HIV-infected patients. HIV-infected patients were referred for HIV-related care during TB treatment.

From July to October 2006, 8% of 1086 new TB patients were known to be HIV-infected at the time of TB diagnosis. Of 1000 patients with unknown HIV status, 93% were tested: HIV infection was diagnosed in 11%. Including patients with previously diagnosed HIV infection, 17% of all TB patients were HIV-infected. Of 99 newly diagnosed HIV patients, 36% received cotrimoxazole prophylaxis. Of 41 with CD4 < 200 cells/microl, 42% began antiretroviral treatment during TB treatment.

The acceptance of DCT was high, but the provision of HIV services was disappointingly low. Increased staff capacity building, stronger coordination with the acquired immune-deficiency syndrome programme and better field supervision are needed to achieve universal access to care for HIV-infected TB patients.