Universal HIV testing in London tuberculosis clinics: a cluster randomised controlled trial

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Clinical Trials

Background:

• Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) co-infection is a significant global health challenge.
• Integrating HIV testing into TB services is crucial for early diagnosis and improved patient outcomes.
• Optimizing HIV testing strategies within TB clinics requires evaluating intervention effectiveness.

Purpose of the Study:

• To evaluate the impact of combined interventions on HIV testing uptake in London tuberculosis clinics.
• To assess changes in HIV test offers, acceptance, and overall coverage.
• To determine if a shift from selective to universal HIV testing policies enhances testing rates.

Main Methods:

• A stepped-wedge cluster randomized controlled trial involving 24 London TB clinics.
• Interventions included staff training, information resources, and policy changes towards universal HIV testing.
• Primary outcome: HIV test acceptance; Secondary outcomes: HIV test offer and coverage.

Main Results:

• Significant increases in HIV test offers and coverage were observed across clinics, regardless of existing universal testing policies.
• HIV test acceptance did not significantly improve in clinics with or without routine universal testing.
• The intervention successfully boosted the number and proportion of HIV tests performed, though the increase was modest.

Conclusions:

• Combined interventions effectively increased the offer and coverage of HIV testing within TB clinics.
• HIV test acceptance rates remained stable, suggesting high baseline acceptance or limitations of the intervention in improving this specific metric.
• The findings support the integration of HIV testing into routine TB care, with potential for modest but significant increases in testing uptake.