Elevated HIV seroprevalence and risk behavior among Ugandan TB suspects: implications for HIV testing and prevention.
OBJECTIVE
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.
Srikantiah
P
P
Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco 94110, USA. psrikantiah@php.ucsf.edu
Lin
R
R
Walusimbi
M
M
Okwera
A
A
Luzze
H
H
Whalen
C C
CC
Boom
W H
WH
Havlir
D V
DV
Charlebois
E D
ED
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D015528:HIV Seroprevalence; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D012309:Risk-Taking; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*; D014454:Uganda / Q000453:epidemiology