title: Enhanced tuberculosis case detection among substitution treatment patients: a randomized controlled trial.
abstract: BACKGROUND
  Historically, HIV, TB (tuberculosis) and illegal drug treatment services in Estonia have been developed as vertical structures. Related health care services are often provided by different health care institutions and in different locations. This may present obstacles for vulnerable groups, such as injecting drug users (IDU), to access the needed services. We conducted a small scale randomized controlled trial to evaluate a case management intervention aimed at increasing TB screening and treatment entry among IDUs referred from a methadone drug treatment program in Jõhvi, North-Eastern Estonia.
  
  
  RESULTS
  Of the 189 potential subjects, 112 (59%) participated. HIV prevalence was 86% (n = 96) and 7.4% (n = 8) of participants were interferon gamma release assay (IGRA) positive (6.5% were both HIV and IGRA-positive, n = 7). Overall, 44% of participants (n = 49) attended TB clinic, 17 (30%) from control group and 32 (57%) from case management group (p = 0.004). None of the participants were diagnosed with TB. In a multivariate model, those randomized to case management group were more likely to access TB screening services.
  
  
  CONCLUSIONS
  These findings demonstrate the urgent need for scaling up TB screening among IDUs and the value of more active approach in referring substitution treatment patients to TB services.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01290081.
authors.affiliation: Department of Infectious Diseases and Drug Abuse Prevention, National Institute for Health Development, Tallinn 11619, Estonia. kristi.ruutel@tai.ee.
authors.forename: Kristi
authors.initials: K
authors.lastname: Rüütel
authors.forename: Helle-Mai
authors.initials: HM
authors.lastname: Loit
authors.forename: Tiiu
authors.initials: T
authors.lastname: Sepp
authors.forename: Kai
authors.initials: K
authors.lastname: Kliiman
authors.forename: Louise-Anne
authors.initials: LA
authors.lastname: McNutt
authors.forename: Anneli
authors.initials: A
authors.lastname: Uusküla