title: Peer-led active tuberculosis case-finding among people living with HIV: lessons from Nepal.
abstract: OBJECTIVE
  People living with a human immunodeficiency virus (HIV) infection have a high risk of tuberculosis and should undergo regular screening. However, they can be difficult to reach because they are stigmatized and discriminated against.
  
  
  METHODS
  In Nepal, the nongovernmental organization Naya Goreto implemented a peer-led tuberculosis screening project in which people living with HIV volunteered to contact others in this high-risk population. Volunteers took part in a short training course, after which they attempted to contact people living with HIV through existing networks and self-help groups. Tuberculosis screening and testing were carried out in accordance with national guidelines.
  
  
  METHODS
  In Nepal, the prevalence of HIV infection is 0.3% in the general population but is much higher, at 6%, in people in Kathmandu who inject drugs. To date, the health system has not been able to implement systematic tuberculosis screening in people living with HIV.
  
  
  RESULTS
  Between May 2014 and mid-September 2015, 30 volunteers screened 6642 people in 10 districts, 5430 (82%) of whom were living with HIV. Of the 6642, 6046 (91%) were tested for tuberculosis and 287 (4.3%) were diagnosed with the disease, 240 of whom were HIV-positive. Of those with tuberculosis, 270 (94%) initiated treatment.
  
  
  CONCLUSIONS
  Using peers to contact people living with HIV for tuberculosis screening resulted in a high participation rate and the identification of a considerable number of HIV-positive tuberculosis patients. Follow-up during treatment was difficult in this highly mobile group and needs more attention in future interventions.
authors.affiliation: Naya Goreto, Kathmandu, Nepal .
authors.forename: Dipu
authors.initials: D
authors.lastname: Joshi
authors.affiliation: Naya Goreto, Kathmandu, Nepal .
authors.forename: Raisha
authors.initials: R
authors.lastname: Sthapit
authors.affiliation: PHTB Consult, Lovensestraat 79, Tilburg, 5014 DN, Netherlands .
authors.forename: Miranda
authors.initials: M
authors.lastname: Brouwer
mesh_terms: D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006302:Health Services Research; D006801:Humans; D008297:Male; D009390:Nepal / Q000453:epidemiology; D010379:Peer Group; D015397:Program Evaluation; D012657:Self-Help Groups; D012944:Social Support; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology*; D014838:Volunteers