Wide Variations in Compliance with Tuberculosis Screening Guidelines and Tuberculosis Incidence between Antiretroviral Therapy Facilities - Côte d'Ivoire.
BACKGROUND
In Côte d'Ivoire, tuberculosis (TB) is a common cause of death among HIV-infected antiretroviral therapy (ART) enrollees. Ivorian guidelines recommend screening for TB and initiation of TB treatment before ART initiation. Compliance with these guidelines can help reduce TB-related mortality during ART and possibly nosocomial TB transmission.


RESULTS
In a retrospective cohort study among 3,682 randomly selected adults (≥15 years old) starting ART during 2004-2007 at 34 randomly selected facilities, documentation of TB screening completion, prevalence of active TB at ART initiation, and incidence of TB during ART were evaluated. At ART initiation, median age was 36 years, 67% were female, and median CD4 count was 135 cells/μL. Among all 3,682 enrollees, 73 (2%) were on TB treatment at the time of referral to the ART facility. Among the 3,609 not on TB treatment, 1,263 (36%) were documented to receive some TB screening before ART initiation; 21% were screened for cough, 21% for weight loss, 18% for fever, 18% for TB contacts, and 12% for night sweats. Among the 1,263 screened, 111 (11%) were diagnosed with TB and started TB treatment before ART. No associations between patient characteristics and probability of being screened were noted. However, documentation of TB screening completion before ART varied widely by ART facility from 0-100%. TB incidence during ART was 3.0 per 100 person-years but varied widely by ART facility from 0/100 person-year to 13.1/100 person-years.


CONCLUSIONS
Screening for TB before ART initiation was poorly documented. Facility-level variations in TB screening documentation suggest facility-level factors, such as investment in training programs, might determine documentation practices. Targeting under-performing ART facilities with improvement activities is needed. Variations among facilities in TB incidence warrant further research. These incidence variations could reflect differences between facilities in TB screening, diagnostic tests, documentation practices, or TB risk possibly related to infection control practices or local community TB incidence.
Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Andrew F
http://orcid.org/0000-0001-5089-9163
AF
Auld
Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Michela
M
Blain
Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Abidjan, Côte d'Ivoire.
Kunomboa Alexandre
KA
Ekra
Elizabeth Glaser Pediatric AIDS Foundation, Abidjan, Côte d'Ivoire.
Joseph Sylvain
JS
Kouakou
Ministry of Health, National Program for Medical Care of Persons Living with HIV/AIDS, Abidjan, Côte d'Ivoire.
Virginie
V
Ettiègne-Traoré
Ministry of Health, National Program for Medical Care of Persons Living with HIV/AIDS, Abidjan, Côte d'Ivoire.
Moise Zanga
MZ
Tuho
Elizabeth Glaser Pediatric AIDS Foundation, Abidjan, Côte d'Ivoire.|Directorate General of Budget and Finance, Department of Economy and Finance, Abidjan, Côte d'Ivoire.
Fayama
F
Mohamed
Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Ray W
RW
Shiraishi
Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Jennifer
J
Sabatier
Elizabeth Glaser Pediatric AIDS Foundation, Abidjan, Côte d'Ivoire.
Joseph
J
Essombo
Elizabeth Glaser Pediatric AIDS Foundation, Los Angeles, California, United States of America.
Georgette
G
Adjorlolo-Johnson
Elizabeth Glaser Pediatric AIDS Foundation, Los Angeles, California, United States of America.
Richard
R
Marlink
Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Tedd V
TV
Ellerbrock
D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage; D018791:CD4 Lymphocyte Count; D007560:Cote d'Ivoire / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D015497:HIV-1; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012189:Retrospective Studies; D014376:Tuberculosis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control
D044966:Anti-Retroviral Agents