HIV testing of persons referred for tuberculosis diagnosis (TB suspects)
is recommended by World Health Organization but is not a policy in
India, where HIV prevalence among TB suspects has never been reported.
The current Indian policy of offering HIV testing only to TB cases may
limit opportunities for early HIV diagnosis and treatment.
In this study all adult TB suspects examined for diagnostic sputum
microscopy in Mandya district (2 million population), in December 2010,
were offered voluntary HIV counseling and testing. Participants were
assessed for subsequent TB diagnosis.
Of 1668 eligible TB suspects, HIV status was ascertained for 1539 (92%).
Among these, 108 (7%) were HIV positive. Of the 108, 43 (40%) were newly
diagnosed as HIV (ie, not previously known to have HIV infection). To
detect a new case of HIV infection, the number needed to screen among TB
patients was 13, as compared to an number needed to screen of 37 among
\"TB suspects not diagnosed as TB\". Applied annually in 2010, HIV
testing of TB suspects in 2010 could have identified approximately 534
newly diagnosed HIV cases, a 51% increase in district HIV case finding.
It was concluded that routine HIV testing of TB suspects was feasible
and yielded a large number of HIV cases in absolute terms and would
increase district HIV case finding by 51%. The number of patients needed
to be HIV tested to find a previously undetected HIV case among TB
suspects was greater than for TB cases but was potentially acceptable.
Given heterogeneity of HIV epidemic in India, broader surveillance is
required before national policy decision.
Naik, B.; Kumar, A.; Kumaraswamy, L.; Doddamani, S.; Krishnappa, M.; Indander, V.; Satyanarayana, S.; Gupta, D.; Dewan, PK. HIV Prevalence Among Persons Suspected of Tuberculosis. JAIDS Journal of Acquired Immune Deficiency Syndromes (2012) 59 (4) e72-e76. [DOI: 10.1097/QAI.0b013e318245c9df]
HIV prevalence among persons suspected of tuberculosis: policy implications for India.