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TB Screening Among People Living With HIV in PEPFAR Countries

For patients living with HIV, 4-symptom tuberculosis (TB) screening is recommended at every clinical encounter. This is critically important because about 500,000 cases of TB among people living with HIV are estimated to go unreported each year.

At the annual Conference on Retroviruses and Opportunistic Infections (CROI 2020), investigators from the US Centers for Disease Control and Prevention (CDC) and the US Agency for International Development virtually presented a poster on TB screening programs in countries supported by the US Presidents Emergency Plan for AIDS Relief (PEPFAR).

The investigators analyzed diagnostic testing data from PEPFAR-supported sites from October 2017 through March 2019. Countries that reported ≥90% TB screening data completeness were included in the analysis.

The investigators compared the proportion of patients screened for TB symptoms with those who screened positive among people living with HIV who were newly initiating antiretroviral therapy (ART), versus those who had already begun ART by the time they were screened.

Out of 30 countries reporting any TB screening data, 20 qualified for inclusion.

Among 8,337,799 people living with HIV, 7,273,266 people (87%) were screened for TB symptoms at least once in the most recent reporting period. The pooled rate of positive TB symptom screens was 2.6% overall.

Among ART-naïve people living with HIV, the pooled rate of positive TB symptom screens was 7.0%.

Among people living with HIV who had already begun ART, the pooled rate of positive TB symptom screens was 2.3%.

Since 2017, the rate of positive TB screens increased from 3.9% to 6.9% among people living with HIV who are ART-naïve. Among people living with HIV already receiving ART, the rate of positive TB screens decreased from 3.4% to 2.8%.

While the proportion of ART-naïve people living with HIV who screen positive for TB is increasing, the number remains lower than expected in high-burden settings which could represent gaps in TB diagnostic services. Roughly 1 in 6 people living with HIV in the data presented, for example, does not receive diagnostic testing.

World TB Day was commemorated on March 24th. The date is the anniversary of the day in 1882 that Robert Koch, MD, announced the discovery of Mycobacterium tuberculosis.

In an article on World TB Day, in CDC’s Morbidity and Mortality Weekly Report authors shared information about the overlap between TB and HIV. In 2018, 1.8 million people living with HIV began TB preventative treatment, which is an 88% increase from 2017.
The theme this year was “It’s Time.” The theme highlights that now is the time to scale up access to prevention and treatment, to ensure sustainable resources are dedicated to TB research, and to ramp up an equitable global strategy to control an infectious disease that is responsible for immense social burdens.

The poster, Tuberculosis Evaluation Among HIV-Positive Patients On Antiretroviral Therapy, was virtually presented at the 2020 Conference on Retroviruses and Opportunistic Infections.
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