Meeting News CoveragePerspective

Integrating TB screening into large-scale household HIV interventions increases diagnoses

BOSTON — A large-scale strategy in which health care providers visited and screened individual households for HIV and TB appeared feasible and could increase diagnoses of these diseases in highly affected regions, according to data presented at CROI 2016.

“In Africa, TB continues to be the [greatest] cause of mortality among people living with HIV,” Comfort Rutty Phiri, of the ZAMBART public health research group based in Lusaka, Zambia, said during a presentation. “We need to come up with innovative ways to prevent both HIV and TB, and reduce the mortality associated with both diseases.”

Comfort Rutty Phiri

Comfort Rutty Phiri

Phiri and colleagues examined the practicality of a dual-purpose intervention campaign using data collected from the HPTN 071 (PopART) study, a three-arm randomized trial investigating combination prevention interventions within 21 Zambian and South African communities. Primarily focused on HIV care and diagnosis, the study recruited community HIV care providers (CHiPs) to deliver door-to-door testing, prevention support and, in the case of a positive result, prompt linkage to care. In eight of these communities, an intervention including TB screening and services also was provided to visited households.

To detect TB, CHiPs used a standard questionnaire to identify the most common symptoms of TB infection — such as weight loss, persistent cough or night sweats — and were instructed to collect sputum samples from symptomatic adults. Samples were delivered to clinics for smear microscopy or GeneXpert (Cepheid) testing, and adults positive for the infection were referred to the clinic to begin TB treatment.

Phiri and colleagues analyzed household data concerning diagnosis and linkage to care incidence resulting from these joint HIV/TB interventions from November 2013 to June 2015. Of the 102,511 households visited, 97% consented to enumeration, and 84% of adults consented to participate in the program (n = 212,819). More than half of these were males, and the median age of participants was 29 years.

More than 98% of consenting adults received the TB screening. Among these, 1.2% demonstrated one or more symptoms of TB infection, three-quarters of whom underwent testing and received their results. TB tests were positive for 8.7% of the tested adults, and 79.6% of diagnosed participants initiated TB treatment. In addition, 55% of diagnosed adults and 55.5% of those whom initiated TB therapy were found to be coinfected with HIV.

Phiri noted a number of issues challenging the effectiveness of the home-to-home intervention, such as the low percentage of symptomatic individuals, frequent loss to follow-up and difficulty reaching adults who frequently are away from home. Although the TB diagnosis rate was lower than initially expected by the researchers, Phiri said these results suggest that adding TB screening to large-scale HIV home testing could be a viable strategy.

“We found that screening large numbers of individuals for TB using a standard set of questions as part of a large, community-based household HIV intervention is feasible,” Phiri said. – by Dave Muoio

Reference:

Phiri CR, et al. Abstract 156. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 22-25, 2016; Boston.

Disclosure: The researchers report no relevant financial disclosures.

BOSTON — A large-scale strategy in which health care providers visited and screened individual households for HIV and TB appeared feasible and could increase diagnoses of these diseases in highly affected regions, according to data presented at CROI 2016.

“In Africa, TB continues to be the [greatest] cause of mortality among people living with HIV,” Comfort Rutty Phiri, of the ZAMBART public health research group based in Lusaka, Zambia, said during a presentation. “We need to come up with innovative ways to prevent both HIV and TB, and reduce the mortality associated with both diseases.”

Comfort Rutty Phiri

Comfort Rutty Phiri

Phiri and colleagues examined the practicality of a dual-purpose intervention campaign using data collected from the HPTN 071 (PopART) study, a three-arm randomized trial investigating combination prevention interventions within 21 Zambian and South African communities. Primarily focused on HIV care and diagnosis, the study recruited community HIV care providers (CHiPs) to deliver door-to-door testing, prevention support and, in the case of a positive result, prompt linkage to care. In eight of these communities, an intervention including TB screening and services also was provided to visited households.

To detect TB, CHiPs used a standard questionnaire to identify the most common symptoms of TB infection — such as weight loss, persistent cough or night sweats — and were instructed to collect sputum samples from symptomatic adults. Samples were delivered to clinics for smear microscopy or GeneXpert (Cepheid) testing, and adults positive for the infection were referred to the clinic to begin TB treatment.

Phiri and colleagues analyzed household data concerning diagnosis and linkage to care incidence resulting from these joint HIV/TB interventions from November 2013 to June 2015. Of the 102,511 households visited, 97% consented to enumeration, and 84% of adults consented to participate in the program (n = 212,819). More than half of these were males, and the median age of participants was 29 years.

More than 98% of consenting adults received the TB screening. Among these, 1.2% demonstrated one or more symptoms of TB infection, three-quarters of whom underwent testing and received their results. TB tests were positive for 8.7% of the tested adults, and 79.6% of diagnosed participants initiated TB treatment. In addition, 55% of diagnosed adults and 55.5% of those whom initiated TB therapy were found to be coinfected with HIV.

Phiri noted a number of issues challenging the effectiveness of the home-to-home intervention, such as the low percentage of symptomatic individuals, frequent loss to follow-up and difficulty reaching adults who frequently are away from home. Although the TB diagnosis rate was lower than initially expected by the researchers, Phiri said these results suggest that adding TB screening to large-scale HIV home testing could be a viable strategy.

“We found that screening large numbers of individuals for TB using a standard set of questions as part of a large, community-based household HIV intervention is feasible,” Phiri said. – by Dave Muoio

Reference:

Phiri CR, et al. Abstract 156. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 22-25, 2016; Boston.

Disclosure: The researchers report no relevant financial disclosures.

    Perspective
    Richard E. Chaisson

    Richard E. Chaisson

    Community health workers trained to identify people with HIV and do HIV testing in the community were also able to offer TB screening to a very large number of people, and identify people with TB symptoms and obtain sputum specimens to test for TB. The lesson of this study is that community health workers who do not have an advanced degree, who do not have medical training, and who have rudimentary training to identify symptoms can successfully identify and refer into treatment people who have TB in the community.

    • Richard E. Chaisson, MD
    • Director of the Johns Hopkins Center for TB Research

    Disclosures: Chaisson reports no relevant financial disclosures.

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