title: HIV-infected presumptive tuberculosis patients without tuberculosis: How many are eligible for antiretroviral therapy in Karnataka, India?
abstract: For certain subgroups within people living with the human immunodeficiency virus (HIV) [active tuberculosis (TB), pregnant women, children <5years old, and serodiscordant couples], the World Health Organization recommends antiretroviral therapy (ART) irrespective of CD4 count. Another subgroup which has received increased attention is "HIV-infected presumptive TB patients without TB". In this study, we assess the proportion of HIV-infected presumptive TB patients eligible for ART in Karnataka State (population 60million), India. This was a cross-sectional analysis of data of HIV-infected presumptive TB patients diagnosed in May 2015 abstracted from national TB and HIV program records. Of 42,585 presumptive TB patients, 28,964 (68%) were tested for HIV and 2262 (8%) were HIV positive. Of the latter, 377 (17%) had active TB. Of 1885 "presumptive TB patients without active TB", 1100 (58%) were already receiving ART. Of the remaining 785 who were not receiving ART, 617 (79%) were assessed for ART eligibility and of those, 548 (89%) were eligible for ART. About 90% of "HIV-infected presumptive TB patients without TB" were eligible for ART. This evidence supports a public health approach of starting all "HIV-infected presumptive TB patients without TB" on ART irrespective of CD4 count in line with global thinking about 'test and treat'.
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India. Electronic address: akumar@theunion.org.
authors.forename: Ajay M V
authors.initials: AMV
authors.lastname: Kumar
authors.affiliation: State TB Cell, Directorate of Health Services, Bangalore, Karnataka, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Singarajipura
authors.affiliation: World Health Organization Country Office, New Delhi, India.
authors.forename: Balaji
authors.initials: B
authors.lastname: Naik
authors.affiliation: World Health Organization Country Office, New Delhi, India.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Guddemane
authors.affiliation: World Health Organization Country Office, New Delhi, India.
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Patel
authors.affiliation: State TB Cell, Directorate of Health Services, Bangalore, Karnataka, India.
authors.forename: Suresh
authors.initials: S
authors.lastname: Shastri
authors.affiliation: Karnataka State AIDS Prevention Society, Bangalore, Karnataka, India; National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kumar
authors.affiliation: National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Deshmukh
authors.affiliation: National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India.
authors.forename: B B
authors.initials: BB
authors.lastname: Rewari
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Anthony David
authors.initials: AD
authors.lastname: Harries
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015897:Comorbidity; D003371:Cough / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D014376:Tuberculosis
chemical_list: D044966:Anti-Retroviral Agents
keywords: ART eligibility; ART initiation criteria; HIV-infected TB suspects; HIV-infected presumptive TB patients; Operational research; WHO 2013 ART guidelines
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