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Are HIV-positive presumptive tuberculosis patients without tuberculosis getting the care they need in Zimbabwe?
R A Dlodlo1, Z E Hwalima2, S Sithole2
1International Union Against Tuberculosis and Lung Disease, Bulawayo, Zimbabwe.
Setting:
Emakhandeni Clinic provides decentralised and integrated tuberculosis (TB) and human immunodeficiency virus (HIV) care in Bulawayo, Zimbabwe.
Objectives:
To compare HIV care for presumptive TB patients with and without TB registered in 2013.
Design:
Retrospective cohort study using routine programme data.
Results:
Of 422 registered presumptive TB patients, 26% were already known to be HIV-positive. Among the remaining 315 patients, 255 (81%) were tested for HIV, of whom 190 (75%) tested HIV-positive. Of these, 26% were diagnosed with TB and 71% without TB (3% had no TB result recorded). For the 134 patients without TB, antiretroviral treatment (ART) eligibility data were recorded for 42 (31%); 95% of these were ART eligible. Initiation of cotrimoxazole preventive therapy (CPT) and ART was recorded for respectively 88% and 90% of HIV-positive patients with TB compared with respectively 40% and 38% of HIV-positive patients without TB (P < 0.001).
Conclusion:
Presumptive TB patients without TB had a high HIV positivity rate and, for those with available data, most were ART eligible. Unlike HIV-positive patients diagnosed with TB, CPT and ART uptake for these patients was poor. A 'test and treat' approach and better service linkages could be life-saving for these patients, especially in southern Africa, where there are high burdens of HIV and TB.
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