Provider-initiated HIV testing increases access of patients with HIV-associated tuberculosis to antiretroviral treatment

Lawn, Stephen D.; Fraenzel, Anna; Kranzer, Katharina; Caldwell, Judy; Bekker, Linda‐Gail; Wood, Robin

doi:10.7196/samj.4392

Cited by 30 publications

(37 citation statements)

References 12 publications

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“…26 It also increases patient and provider acceptability of HIV testing 27,28 and improves linkage to antiretroviral treatment for HIV-infected patients. 29 Finally, HIV testing is cost-effective compared with no testing when the HIV-infection prevalence is at least 1.0 per 1000 persons screened, as it was in our population of TB patients. 30 Provider type was also an important factor in HIV status determination.…”

Section: Discussionmentioning

confidence: 99%

HIV Status Determination Among Tuberculosis Patients From California During 2008

Kong

Watt

Marks

et al. 2013

Journal of Public Health Management and Practice

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Context-Human immunodeficiency virus (HIV) infection complicates care and contributes to poor outcomes among tuberculosis (TB) patients. The Centers for Disease Control and Prevention recommends that providers test all TB patients for HIV.Objective-We assessed completeness of HIV status determination among TB patients and identified key gaps in adherence.Design-We conducted a retrospective review of public health charts to determine the HIV status for all TB patients reported in California during 2008. We then used logistic regression to determine the factors associated with a known (positive or negative) HIV status. A random sample of TB patients was selected for secondary review to characterize the timing of HIV status determination and the providers who had opportunity to test for HIV. Setting-California TB programs. Participants-All TB patients reported from California in 2008.Main Outcome Measures-Proportion of patients with a known HIV status, adjusted odds ratios for having a known HIV status, proportion of patients with a known HIV status before TB diagnosis, and proportion of patients diagnosed with TB by different provider types.Results-Only 1752 (66%) of 2667 TB patients had a known HIV status. Having a known HIV status was strongly associated with those aged between 15 and 44 years and being managed with any public provider involvement. Of 292 patients in the random sample, 12 patients (4%) had a This also presents a gap in TB management and public health TB control. Human immunodeficiency virus infection is a risk factor for death with TB, 5-9 TB recurrence, 10 and acquired TB drug resistance with intermittent therapy. 11-13 Thus, HIV status determination is needed to identify TB patients who should receive daily directly observed TB therapy and highly active antiretroviral therapy to prevent poor TB outcomes. 14-17 Human immunodeficiency virus status determination is also needed for TB programs to link HIVinfected TB patients to HIV care services and to identify HIV-infected contacts, who are at increased risk for progression to disease. 18 Ensuring complete HIV status determination among patients is part of TB programs' broader responsibility to monitor and ensure the quality of all TB-related activities. However, the decision to test patients for HIV ultimately rests with the provider. Although TB programs can directly implement routine HIV testing for patients in public TB clinics, they have less influence over the care given by private providers. Therefore, public health efforts to ensure complete HIV status determination must consider the provider types involved in TB care and target interventions appropriately. HHS Public AccessWe conducted an evaluation of TB patients reported from California in 2008 to (1) assess completeness of HIV status determination, (2) identify factors associated with having a known HIV status, (3) characterize providers who have opportunity to test for HIV during TB care, and (4) provide recommendations to increase HIV status determination completeness. Me...

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Section: Discussionmentioning

confidence: 99%

HIV Status Determination Among Tuberculosis Patients From California During 2008

Kong

Watt

Marks

et al. 2013

Journal of Public Health Management and Practice

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“…24 However, other articles reported increased access to care and treatment after provider-initiated HIV testing and counselling. 26–28 Challenges to implementation of provider-initiated HIV testing and counselling—eg, logistics, data systems, human resources, and management—were reported. 23 We found no articles that examined models of provider-initiated counselling specifically comparing the effectiveness of brief versus detailed HIV counselling.…”

Section: Figurementioning

confidence: 99%

Abbreviated HIV counselling and testing and enhanced referral to care in Uganda: a factorial randomised controlled trial

Wanyenze

Kamya

Fatch

et al. 2013

The Lancet Global Health

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SummaryBackgroundHIV counselling and testing and linkage to care are crucial for successful HIV prevention and treatment. Abbreviated counselling could save time; however, its effect on HIV risk is uncertain and methods to improve linkage to care have not been studied.MethodsWe did this factorial randomised controlled study at Mulago Hospital, Uganda. Participants were randomly assigned to abbreviated or traditional HIV counselling and testing; HIV-infected patients were randomly assigned to enhanced linkage to care or standard linkage to care. All study personnel except counsellors and the data officer were masked to study group assignment. Participants had structured interviews, given once every 3 months. We compared sexual risk behaviour by counselling strategy with a 6·5% non-inferiority margin. We used Cox proportional hazards analyses to compare HIV outcomes by linkage to care over 1 year and tested for interaction by sex. This trial is registered with ClinicalTrials.gov (NCT00648232).FindingsWe enrolled 3415 participants; 1707 assigned to abbreviated counselling versus 1708 assigned to traditional. Unprotected sex with an HIV discordant or status unknown partner was similar in each group (232/823 [27·9%] vs 251/890 [28·2%], difference −0·3%, one-sided 95% CI 3·2). Loss to follow-up was lower for traditional counselling than for abbreviated counselling (adjusted hazard ratio [HR] 0·61, 95% CI 0·44–0·83). 1003 HIV-positive participants were assigned to enhanced linkage (n=504) or standard linkage to care (n=499). Linkage to care did not have a significant effect on mortality or receipt of co-trimoxazole. Time to treatment in men with CD4 cell counts of 250 cells per μL or fewer was lower for enhanced linkage versus standard linkage (adjusted HR 0·60, 95% CI 0·41–0·87) and time to HIV care was decreased among women (0·80, 0·66–0·96).InterpretationAbbreviated HIV counselling and testing did not adversely affect risk behaviour. Linkage to care interventions might decrease time to enrolment in HIV care and antiretroviral treatment and thus might affect secondary HIV transmission and improve treatment outcomes.FundingUS National Institute of Mental Health.

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“…A Zimbabwe study in 2005 compared mother-to-child transmission (PMTCT) service indicators during a 6 month routine HIV testing period with the prior opt-in testing period and found significantly more women in the routine testing period received their test results and were post-test counselled and more mother-infant pairs were seen at their 6 week follow-up visits [16]. Stronger evidence emerged from a South African retrospective review that found a statistically significant temporal association between the introduction of PITC for patients with TB in 2005, and subsequent increased referrals to ART (from 16% in the period 2002–2005 to 34.7% in 2007–2008) [17]. …”

Section: Introductionmentioning

confidence: 99%

A comparison of linkage to HIV care after provider-initiated HIV testing and counselling (PITC) versus voluntary HIV counselling and testing (VCT) for patients with sexually transmitted infections in Cape Town, South Africa

Leon

Mathews

Lewin

et al. 2014

BMC Health Serv Res

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BackgroundWe examined linkage to care for patients with sexually transmitted infection who were diagnosed HIV-positive via the provider-initiated HIV testing and counselling (PITC) approach, as compared to the voluntary counselling and testing (VCT) approach, as little is known about the impact of expanded testing strategies on linkage to care.MethodsIn a controlled trial on PITC (Cape Town, 2007), we compared HIV follow-up care for a nested cohort of 930 HIV-positive patients. We cross-referenced HIV testing and laboratory records to determine access to CD4 and viral load testing as primary outcomes. Secondary outcomes were HIV immune status and time taken to be linked to HIV care. Logistic regression was performed to analyse the difference between arms.ResultsThere was no difference in the main outcomes of patients with a record of CD4 testing (69.9% in the intervention, 65.2% in control sites, OR 0.82 (CI: 0.44-1.51; p = 0.526) and viral load testing (14.9% intervention versus 10.9% control arm; OR 0.69 (CI: 0.42-1.12; p = 0.131). In the intervention arm, ART-eligible patients (based on low CD4 test result), accessed viral load testing approximately 2.5 months sooner than those in the control arm (214 days vs. 288 days, HR: 0.417, 95% CI: 0.221-0.784; p = 0.007).ConclusionThe PITC intervention did not improve linkage to CD4 testing, but shortened the time to viral load testing for ART-eligible patients. Major gaps found in follow-up care across both arms, indicate the need for more effective linkage-to-HIV care strategies.Trial registrationCurrent Controlled Trials ISRCTN93692532Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-350) contains supplementary material, which is available to authorized users.

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Provider-initiated HIV testing increases access of patients with HIV-associated tuberculosis to antiretroviral treatment

Cited by 30 publications

References 12 publications

HIV Status Determination Among Tuberculosis Patients From California During 2008

HIV Status Determination Among Tuberculosis Patients From California During 2008

Abbreviated HIV counselling and testing and enhanced referral to care in Uganda: a factorial randomised controlled trial

A comparison of linkage to HIV care after provider-initiated HIV testing and counselling (PITC) versus voluntary HIV counselling and testing (VCT) for patients with sexually transmitted infections in Cape Town, South Africa

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