Provider-initiated HIV testing and TB screening in the era of universal coverage: are the right people being reached? A cohort study in Blantyre, Malawi

Mair, L. et al. (2020) Provider-initiated HIV testing and TB screening in the era of universal coverage: are the right people being reached? A cohort study in Blantyre, Malawi. PLoS ONE, 15(8), e0236407. (doi: 10.1371/journal.pone.0236407) (PMID:32790669) (PMCID:PMC7425889)

Abstract

Introduction: Patients with tuberculosis (TB) symptoms have high prevalence of HIV, and should be prioritised for HIV testing. Methods: In a prospective cohort study in Bangwe primary care clinic, Blantyre, Malawi, all adults (18 years or older) presenting with an acute illness were screened for TB symptoms (cough, fever, night sweats, weight loss). Demographic characteristics were linked to exit interview by fingerprint bioidentification. Multivariable logistic regression models were constructed to estimate the proportion completing same-visit HIV testing, comparing between those with and without TB symptoms. Results: There were 5427 adult attendees between 21/5/2018 and 6/9/2018. Exit interviews were performed for 2402 (44%). 276 patients were excluded from the analysis, being already on antiretroviral therapy (ART). Presentation with any TB symptom was common for men (54.6%) and women (57.4%). Overall 27.6% (585/ 2121) attenders reported being offered testing and 21.5% (455/2121) completed provider-initiated HIV testing and counselling (PITC) and received results. The proportions offered testing were similar among participants with and without TB symptoms (any TB symptom: 29.0% vs. 25.7%). This was consistent for each individual symptom; cough, weight loss, fever and night sweats. Multivariable regression models indicated men, younger adults and participants who had previously tested were more likely to complete PITC than women, older adults and those who had never previously tested. Conclusions: Same-visit completion of HIV testing was suboptimal, especially among groups known to have high prevalence of undiagnosed HIV. As countries approach universal coverage of ART, identifying and prioritising currently underserved groups for HIV testing will be essential.

• Item Type: Articles
• Additional Information: Peter MacPherson is funded by Wellcome (206575). Elizabeth L Corbett is funded by Wellcome (200901). Emily L Webb is funded by the UK Medical Research Council (grant reference MR/R010161/1), this award is jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement and is also part of the EDCTP2 programme supported by the European Union.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Peter
• Authors: Mair, L., Corbett, E. L., Feasey, H. R.A., Kamchedzera, W., Khundi, M., Lalloo, D. G., Maheswaran, H., Nliwasa, M., Squire, S. B., Webb, E. L., and MacPherson, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: PLoS ONE
• Publisher: Public Library of Science
• ISSN: 1932-6203
• ISSN (Online): 1932-6203
• Copyright Holders: Copyright © 2020 Mair et al.
• First Published: First published in PLoS ONE 15(8):e0236407
• Publisher Policy: Reproduced under a Creative Commons licence