High yield of new HIV diagnoses during active case-finding for tuberculosis

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• HIV/AIDS Research

Background:

• Undiagnosed Human Immunodeficiency Virus (HIV) infection remains a significant public health challenge, contributing to disease progression and transmission.
• Effective screening strategies are crucial for early detection and linkage to care, particularly in high-burden settings.
• Integrating HIV screening with other infectious disease diagnostics, such as tuberculosis, may enhance case detection.

Purpose of the Study:

• To assess the effectiveness of a general symptom-based screening tool in identifying individuals with previously undiagnosed HIV.
• To analyze the yield of HIV diagnoses from a broad symptom screen in a real-world setting.

Main Methods:

• Secondary analysis of operational data from a cluster-randomized tuberculosis trial in western Kenya.
• Symptom data (cough, fever, night sweats, weight loss, difficulty breathing) and HIV testing results were collected from adults in health facilities and mobile screening units.
• Modified Poisson regression was used to identify predictors of new HIV diagnoses among symptomatic adults.

Main Results:

• 3,818 symptomatic adults were identified; 1,424 were referred for HIV testing, and 1,065 accepted (75% acceptance rate).
• 107 new HIV diagnoses were made, with a prevalence of 21% in health facilities and 5% in mobile units.
• Individuals reporting 4-5 symptoms were more than twice as likely to be diagnosed with HIV compared to those reporting 1-3 symptoms.

Conclusions:

• A broad, non-specific symptom screen demonstrated a high yield for detecting new HIV diagnoses.
• Integrating HIV screening with tuberculosis case-finding efforts can potentially bridge detection gaps for both infections.