Sixteen mission hospitals in Zimbabwe that are implementing the 'Test and Treat' programme for people living with the human immunodeficiency virus (HIV). Objectives: To assess linkages of HIV diagnosis to care and treatment, time taken from being diagnosed with HIV infection to initiation of antiretroviral therapy (ART) and 3-month programmatic outcomes for those starting ART. Design: Cross-sectional study using secondary data. Results: Among 972 people newly diagnosed with HIV, 915 (94%) enrolled for HIV care and 771 (79%) were initiated on ART. Enrolment in care and initiation on ART on the same day as testing occurred in respectively 864 (89%) and 628 (65%) newly diagnosed patients. Over 80% of those who underwent HIV testing in maternal and child health departments initiated ART on the same day. Of the 144 (16%) people in care who were not initiated on ART, the principal reason in 102 (71%) was being transferred out. Most patients (90%) on ART were retained in care at 3 months, with transfer out accounting for most of the remainder. Conclusion: The 'Test and Treat' approach was feasible and successful in getting newly HIV-infected people initiated early on ART. More research is needed to better understand the processes, benefits and potential risks.
Tuberculosis (TB) remains one of the most important opportunistic infections among HIV-infected patients. Diagnosing pulmonary TB (PTB) has become problematic because HIV-positive patients tend to be smear negative and smear microscopy is the first line of diagnosis in people suspected to have TB. 1 It is estimated that more than 50% of HIV-infected patients will develop TB in their lifetime, and the annual risk of developing TB if HIV infected is 10%.2 Various studies have shown high mortality rates in HIV-infected TB patients in resource-limited settings.2 HIV infection increases the risk of acquiring TB, alters the clinical presentation of TB and reduces overall survival.3,4 High mortality rates in these patients have been attributed to severe immunosuppression as measured by CD4+ cell count, and to lack of antiretroviral therapy (ART). 5One of the major challenges in resource-limited settings is clinical identification of HIV-infected TB patients who have sufficiently low CD4+ cell counts to merit early initiation of ART without the aid of expensive and not readily available CD4+ cell count tests. Being able to predict who might have a low CD4+ cell count would assist in the prioritisation of TB patients for ART and thus prevent initiation of ART when it is not yet indicated, an important advantage given that ART is a lifelong commitment. Materials and methodsA prospective cohort study was done on consecutive consenting participants presenting at Beatrice Road Infectious Disease Hospital (BRIDH), Harare, Zimbabwe, and meeting the following inclusion criteria: age 18 years and over, HIV positive, sputum smear positive for acid-fast bacilli (AFB), and naïve to both ART and TB treatment. Patients with symptoms and signs suggestive of PTB were asked to produce two sputum specimens (one spot and an early-morning sample) for AFB microscopic examination using the Ziehl-Neelsen (ZN) staining technique. Participants with positive smears for AFB were offered HIV testing and counselling. HIV tests were done using the Determine (Abbott Laboratories; sensitivity 100%, specificity 98.60%) and Capillus (Trinity Biotech, Ireland; sensitivity 97.8%, specificity 99.7%) rapid test kits. Baseline laboratory tests including a CD4 cell count (Partec Cyflow SL3) and full blood count (Sysmex KF21) were done.Socio-demographic data, medical history and the findings on physical examination were recorded using a standardised data collection tool. The baseline body mass index (BMI, kg/m 2 ) and Karnofsky Performance Status (KPS) score were determined at enrolment.A sample size of 80 at 95% confidence interval (CI) was calculated using Epi Info version 6, assuming a population of 10 000 TB cases per year. Data were analysed using STATA version 8 (College Station, Tex., USA).Baseline characteristics were reported as means (standard deviation, SD) or medians (intraquartile range, IQR). Univariate and multivariate analyses were conducted to determine clinical predictors of a low CD4 Clinical predictors of low CD4 count among HIV-infected pu...
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