TB screening program sees success among Rwandans starting HIV care
Intensified case finding proved successful in increasing the proportion of HIV-positive people screened for TB from 2006 to 2011 in Rwanda. Incidence of confirmed TB cases remained constant over that period at 2.2%.
Tuberculosis ranks as the leading cause of morbidity and mortality among HIV-positive people in sub-Saharan Africa. Early TB diagnosis and prompt treatment are critical to stemming the HIV/TB epidemic in the region.
In 2005 Rwanda began intensified TB case finding in line with World Health Organization advice. This analysis used routinely collected program data from Rwandan HIV clinics to chart trends in TB screening and care among people newly enrolled in HIV clinics from 2006 through 2011. Twice-yearly data collection included proportions of HIV-positive people screened for TB, proportions who screened positive, percentage with active TB, and percentage who started TB therapy.
The number of HIV clinics screening for TB jumped 16-fold from 20 in the first half of 2006 to 328 by the end of 2011. The proportion of HIV-positive people screened for TB rose from 77% in the first half of 2006 to 94% at the end of 2011 (P < 0.001).
Over the same period, the proportion of HIV-positive people diagnosed with TB dropped significantly from 23% to 10% (P < 0.001). Throughout the study period, incidence of confirmed TB cases remained constant at 2.2%.
The authors suggest that the declining proportion of HIV-positive people screening positive for TB could reflect earlier HIV diagnosis in Rwanda.
The researchers observe that “strong collaboration between TB and HIV/AIDS programs at both the central and facility levels is a key to successful intensified case finding scale-up.” They propose that “countries can leverage the infrastructure that has been constructed for HIV/AIDS as scaffolding to build upon and benefit other important disease control programs.”
The authors recommend that “countries with limited resources but high HIV and TB disease prevalence should implement WHO-recommended intensified case finding as part of their integrated HIV-TB treatment programs.”
Source: Francois Uwinkindi, Sabin Nsanzimana, David J. Riedel, Ribakare Muhayimpundu, Eric Remera, Michel Gasana, Grace Mutembayire, Agnes Binagwaho. Scaling up intensified tuberculosis case finding in HIV clinics in Rwanda. JAIDS. 2014; 66: e45-e49.
Source: IAS
