title: Scaling up intensified tuberculosis case finding in HIV clinics in Rwanda.
abstract: BACKGROUND
  Tuberculosis (TB) is the leading cause of morbidity and mortality among people living with HIV (PLHIV) in sub-Saharan Africa. Early TB detection and treatment is key to saving lives of PLHIV. Rwanda began implementing intensified TB case finding (ICF) in 2005 in line with World Health Organization policy on TB/HIV collaborative activities. We aimed to describe trends of ICF in PLHIV newly enrolled into HIV clinics.
  
  
  METHODS
  We used routinely collected program data on ICF from facility-based pre-antiretroviral therapy/antiretroviral therapy registers in Rwandan HIV clinics from 2006 to 2011. Semiannual, active data collection for PLHIV newly enrolled into HIV care included proportion screened for TB, proportion screened positive, and percentage with active TB and started anti-TB drugs.
  
  
  RESULTS
  The number of health facilities reporting TB screening indicators increased 16-fold, from 20 facilities in the first semester of 2006 to 328 facilities by the end of 2011. The proportion of patients screened increased progressively from 77% of newly enrolled patients in first semester of 2006 to 94% at the end of 2011 (P < 0.001). The proportion of patients who screened positive decreased over time, from 23% in the first semester of 2006 to 10% at the end of 2011 (P < 0.001). The proportion of active TB cases remained relatively constant over time at 2.2%.
  
  
  CONCLUSIONS
  Rwanda has increased the proportion of newly enrolled PLHIV screened for TB using a simple screening protocol. Countries with limited resources but high HIV and TB disease prevalence should implement ICF as part of their integrated HIV-TB treatment programs.
authors.affiliation: *Rwanda Biomedical Center, Institute of HIV Disease Prevention and Control, Kigali, Rwanda; †Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD; and ‡Ministry of Health, Kigali, Rwanda.
authors.forename: Francois
authors.initials: F
authors.lastname: Uwinkindi
authors.forename: Sabin
authors.initials: S
authors.lastname: Nsanzimana
authors.forename: David J
authors.initials: DJ
authors.lastname: Riedel
authors.forename: Ribakare
authors.initials: R
authors.lastname: Muhayimpundu
authors.forename: Eric
authors.initials: E
authors.lastname: Remera
authors.forename: Michel
authors.initials: M
authors.lastname: Gasana
authors.forename: Grace
authors.initials: G
authors.lastname: Mutembayire
authors.forename: Agnes
authors.initials: A
authors.lastname: Binagwaho
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D008403:Mass Screening; D012042:Registries; D012432:Rwanda / Q000453:epidemiology; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D014944:World Health Organization
chemical_list: D018501:Antirheumatic Agents