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Free Content HIV testing uptake among the household contacts of multidrug-resistant tuberculosis index cases in eight countries

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SETTING: The household contacts (HHCs) of multidrug-resistant tuberculosis (MDR-TB) index cases are at high risk of tuberculous infection and disease progression, particularly if infected with the human immunodeficiency virus (HIV). HIV testing is important for risk assessment and clinical management.

METHODS: This was a cross-sectional, multi-country study of adult MDR-TB index cases and HHCs. All adult and child HHCs were offered HIV testing if never tested or if HIV-negative >1 year previously when last tested. We measured HIV testing uptake and used logistic regression to evaluate predictors.

RESULTS: A total of 1007 HHCs of 284 index cases were enrolled in eight countries. HIV status was known at enrolment for 226 (22%) HHCs; 39 (4%) were HIV-positive. HIV testing was offered to 769 (98%) of the 781 remaining HHCs; 544 (71%) agreed to testing. Of 535 who were actually tested, 26 (5%) were HIV-infected. HIV testing uptake varied by site (median 86%, range 0–100%; P < 0.0001), and was lower in children aged <18 years than in adults (59% vs. 78%; adjusted for site P < 0.0001).

CONCLUSIONS: HIV testing of HHCs of MDR-TB index cases is feasible and high-yield, with 5% testing positive. Reasons for low test uptake among children and at specific sites—including sites with high HIV prevalence—require further study to ensure all persons at risk for HIV are aware of their status.
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Keywords: HCT testing; barriers; willingness to test

Document Type: Research Article

Affiliations: 1: Kenya Medical Research Institute, Kisumu, Kenya 2: Harvard T. H. Chan School of Public Health, Boston, Massachusetts 3: University of Nebraska Medical Center, Omaha, Nebraska 4: Johns Hopkins Medical Institutions, Baltimore, Maryland, USA 5: Desmond Tutu TB Centre, Stellenbosch University, Tygerberg 6: The Aurum Institute, Johannesburg, South Africa 7: Harvard T. H. Chan School of Public Health, Boston, Massachusetts, Frontier Science & Technology Research Foundation, Amherst, New York, USA 8: University of Cape Town Lung Institute, Mowbray, South Africa 9: Byramjee Jeejeebhoy Government Medical College Clinical Trials Unit, Pune, India 10: Asociacion Civil Impacta Salud y Educacion, Barranco Clinical Research Site, Lima 11: Asociación Civil Impacta Salud y Educación, San Miguel Clinical Research Site (CRS), Lima, Peru 12: Chennai Antiviral Research and Treatment CRS, Chennai, India 13: TASK Applied Science CRS, Bellville 14: University of the Witwatersrand, Helen Joseph Hospital, Johannesburg 15: South African Tuberculosis Vaccine Initiative, Cape Town, South Africa 16: GHESKIO (Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes) Centers Institute of Infectious Diseases and Reproductive Health, Port-au-Prince, Haiti 17: Gaborone CRS, Gaborone, Botswana 18: Prevention and Treatment of HIV infection, Chiangrai Prachanukroh Hospital, Chiangrai, Thailand 19: Soweto CRS, Johannesburg 20: Durban International CRS, Durban, South Africa 21: Instituto Nacional de Infectologia/Fundação Oswaldo Cruz, Brazil 22: Social & Scientific Systems, Inc, Silver Springs, Maryland 23: Frontier Science & Technology Research Foundation, Amherst, New York, USA 24: National Institutes of Health, Bethesda, Maryland 25: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Publication date: December 1, 2018

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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