Elevated HIV seroprevalence and risk behavior among Ugandan TB suspects: implications for HIV testing and prevention
Abstract:OBJECTIVES: Voluntary counseling and testing (VCT) for the human immunodeficiency virus (HIV) is recommended for persons treated for tuberculosis (TB). Opportunities to diagnose HIV may be missed by limiting HIV testing to only persons diagnosed with TB. Among TB suspects in Uganda, we determined HIV prevalence, risk behaviors, and willingness to refer family for VCT.
METHODS: Consenting adult patients presenting for evaluation at a referral TB clinic received same-day VCT. TB diagnosis data were abstracted from clinical records.
RESULTS: Among 665 eligible patients, 565 (85%) consented to VCT. Among these, 238 (42%) were HIV-positive. Of the HIV-infected patients, 37% had received a non-TB diagnosis. HIV seroprevalence was higher in patients with a non-TB diagnosis (49%) than those diagnosed with TB (39%) (P = 0.02). Fewer than 6% of HIV-infected patients reported always using condoms with sexual partners. The majority of patients (86%) reported being ‘very willing’ to refer family members for VCT.
CONCLUSIONS: Over 35% of HIV-infected cases in our population would have been undetected if HIV testing was limited to cases with diagnosed TB. The high HIV seroprevalence in both TB and non-TB cases merits HIV testing for all patients evaluated at TB clinics. HIV-infected TB suspects reporting high-risk behavior are at risk for HIV transmission, and should receive risk-reduction counseling.
Document Type: Regular Paper
Affiliations: 1: Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco, California, USA; and Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA 2: Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco, California, USA 3: National Tuberculosis and Leprosy Program, Mulago Hospital, Kampala, Uganda 4: Division of Infectious Diseases and Epidemiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA 5: Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, California, USA
Publication date: February 1, 2007
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