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Principal Investigator(s): Eric Pevzner, PhD, MPH,1 and
Alyssa Finlay, MD1
Project Dates: September-October 2005
Project Overview:
In October 2005, the Rwanda Ministry of Health adopted a new policy that
included routinely providing HIV counseling and testing for all patients with
TB, and providing HIV care for coinfected patients. Prior to policy
implementation, we conducted an evaluation of access to and acceptance of HIV
testing among patients with TB. The evaluation was conducted with the
participation of 22 geographically representative sites (i.e., hospitals and
health centers).
Objectives: The objectives of this project were to 1) identify
and examine barriers to HIV testing among patients and health care workers; 2)
determine the baseline percentage of patients with TB who were offered,
accepted, and received HIV testing prior to implementation of the new TB/HIV
policy; 3) document the percentage of patients with TB disease and HIV
infection; 4) document the HIV-related services for patients with TB disease
and HIV infection; 5) evaluate the treatment outcomes of patients with TB
disease and HIV infection; and 6) examine the level of coordination between TB
and HIV programs.
Target Audience: Rwanda Ministry of Health and other TB/HIV
partners
Methods: Multiple methods were utilized for this project,
including focus group discussions with patients with TB and with health care
workers at TB clinics; face-to-face structured interviews about access to and
acceptance of HIV testing among patients with TB; review and abstraction of
data from TB registers and patient treatment cards; and structured interviews
with staff at the TB clinic, HIV Voluntary Counseling and Testing (VCT) clinic,
and antiretroviral (ARV) clinic at each site.
Results: Patient interviews - Of the 207 patients interviewed, 158 (76%)
reported being offered an HIV test, and 157 (99%) of these patients reported
getting tested. Among 134 patients who disclosed their status, 66 (49%)
reported being HIV infected. Our review of the TB registries and treatment
cards identified 490 patients registered during 10/1/04-12/31/04, with 258
(53%) having a documented HIV test result. Of these patients, 113 (44%) had a
positive HIV test result. Of the 40 TB clinic staff interviewed, 11 (28%)
reported offering HIV testing to 100% of patients with TB, and six reported
offering testing to less than 50% of patients. Review of TB registers and
patient treatment cards - Among the 490 patients registered at the sampled
health facilities, 258 (53%) had an HIV test result documented either in the TB
register or on the treatment card; 113 (44%) were HIV infected. Among 113
patients with TB disease and HIV infection, program data indicated that only 3
(3%) received cotrimoxazole preventive therapy and only 14 (12%) received
antiretroviral therapy. Analysis of treatment outcomes revealed that 28/113
(25%) patients with TB disease and HIV infection died, compared to 7/145 (5%)
non HIV-infected patients with TB (RR= 6.0, 95% CI 2.5-14.5).
Contact Information:
Eric Pevzner, PhD, MPH
Epidemic Intelligence Service Officer
Centers for Disease Control and Prevention
Division of Tuberculosis Elimination
1600 Clifton Road, Mailstop E-10
Atlanta, GA 30333
E-mail: ecp9@cdc.gov
1 Division of Tuberculosis Elimination, Centers for Disease Control and Prevention
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