High yield of new HIV diagnoses during active case-finding for tuberculosis
| Autor: | Douglas Okelloh, Jessica Cowden, Walter Mchembere, Kevin P. Cain, Courtney M. Yuen, Joseph Opole, Millicent Achola, Janet Agaya, Martien W. Borgdorff, Hellen Muttai, Charles M. Heilig |
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| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Adult Male Pediatrics medicine.medical_specialty Tuberculosis Adolescent Yield (finance) Immunology Human immunodeficiency virus (HIV) MEDLINE HIV Infections medicine.disease_cause Article law.invention 03 medical and health sciences Young Adult 0302 clinical medicine Sex Factors Randomized controlled trial law medicine Prevalence Immunology and Allergy Humans Mass Screening 030212 general & internal medicine Young adult Medical diagnosis business.industry Middle Aged medicine.disease Kenya 030104 developmental biology Infectious Diseases Case finding Regression Analysis Female Health Facilities business Mobile Health Units |
| Zdroj: | AIDS |
| ISSN: | 1473-5571 |
| Popis: | OBJECTIVE: To evaluate the utility of a broad and nonspecific symptom screen for identifying people with undiagnosed HIV infection. DESIGN: Secondary analysis of operational data collected during implementation of a cluster-randomized trial for tuberculosis case detection. METHODS: As part of the trial, adults reporting cough, fever, night sweats, weight loss, or difficulty breathing for any duration in the past month were identified in health facilities and community-based mobile screening units in western Kenya. Adults reporting any symptom were offered HIV testing. We analysed the HIV testing data from this study, using modified Poisson regression, to identify predictors of new HIV diagnoses among adults with symptoms and initially unknown HIV status. RESULTS: We identified 3818 symptomatic adults, referred 1424 (37%) for testing, of whom 1065 (75%) accepted, and 107 (10%) were newly diagnosed with HIV. The prevalence of new HIV diagnoses was 21% [95% confidence interval (CI) 17–25%] among those tested in health facilities and 5% (95% CI 4–7%) among those tested in mobile units. More men were diagnosed with HIV than women, despite fewer men being screened. People who reported 4–5 symptoms were over twice as likely to be diagnosed with HIV compared to those reporting 1–3 symptoms (adjusted prevalence ratio in health facilities = 2.58, 95% CI 1.65–4.05; adjusted prevalence ratio in mobile units = 2.63, 95% CI 1.37–5.03). CONCLUSION: We observed a high yield of new HIV diagnoses among adults identified by active application of a broad symptom screen. Use of integrated tuberculosis and HIV screening could help close the detection gap for both conditions. |
| Databáze: | OpenAIRE |
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