Implementation and Operational Research: Population-Based Active Tuberculosis Case Finding During Large-Scale Mobile HIV Testing Campaigns in Rural Uganda
Emmanuel Ssemmondo, Florence Mwangwa, Joel L Kironde, Dalsone Kwarisiima, Tamara D Clark, Carina Marquez, Edwin D Charlebois, Maya L Petersen, Moses R Kamya, Diane V Havlir, Gabriel Chamie, SEARCH Collaboration, Emmanuel Ssemmondo, Florence Mwangwa, Joel L Kironde, Dalsone Kwarisiima, Tamara D Clark, Carina Marquez, Edwin D Charlebois, Maya L Petersen, Moses R Kamya, Diane V Havlir, Gabriel Chamie, SEARCH Collaboration
Abstract
Background: Active tuberculosis (TB) screening outside clinics and in communities may reduce undiagnosed TB.
Methods: To determine the yield of TB screening during community-based HIV testing campaigns (CHC) in 7 rural Ugandan communities within an ongoing cluster-randomized trial of universal HIV testing and treatment (SEARCH, NCT:01864603), we offered sputum microscopy to participants with prolonged cough (>2 weeks). We determined the number of persons needed to screen to identify one TB case, and the number of cases identified that linked to clinic and completed TB treatment.
Results: Of 36,785 adults enumerated in 7 communities, 27,214 (74%) attended CHCs, and HIV testing uptake was >99%, with 941 (3.5%) HIV-infected adults identified. Five thousand seven hundred eighty-six adults (21%) reported cough and 2876 (11%) reported cough >2 weeks. Staff obtained sputum in 1099/2876 (38%) participants with prolonged cough and identified 10 adults with AFB-positive sputum; 9 new diagnoses and 1 known case already under treatment. The number needed to screen to identify one new TB case was 3024 adults overall: 320 adults with prolonged cough and 80 HIV-infected adults with prolonged cough. All 9 newly diagnosed AFB+ participants were linked to TB care within 2 weeks and were initiated TB treatment.
Conclusions: In a rural Ugandan setting, TB screening as an adjunct to large-scale mobile HIV testing campaigns provides an opportunity to increase TB case detection.
Conflict of interest statement
Conflicts of Interest: None of the authors have any conflicts of interest.
Source: PubMed