Provider-initiated HIV testing increases access of patients with HIV-associated tuberculosis to antiretroviral treatment
Background. Timely initiation of antiretroviral treatment (ART) is a critical component of the case management of patients with HIVassociated tuberculosis (TB) and advanced immunodeficiency. We sought to determine the impact of the introduction of providerinitiated HIV-testing in TB clinics in 2005 on subsequent referrals of patients with HIV-associated TB at a community-based ART service in Cape Town. Methods. Retrospective analysis of an ART cohort database (2002 - 2008) stratified by calendar periods. Results. Between 2002 and 2008, 3 770 ART-naive adults enrolled in the ART service. Overall, 27.4% of these patients had been referred from TB clinics with a diagnosis of HIV-associated TB. This proportion increased from 16.0% of referrals in the period 2002 - 2005 prior to the introduction of provider-initiated HIV testing, to 34.7% in 2007 - 2008 (p<0.001). The median duration of TB treatment completed prior to referral decreased from 3 months to 1 month (p<0.001) and patients enrolled with higher median CD4 cell counts (71 cells/μl v. 95 cells/μl; p<0.001). Moreover, the proportion with recurrent TB episodes decreased from 8.6% to 3.2% (p<0.001). Conclusions. Introduction of provider-initiated HIV testing by the TB control programme was temporally associated with a major increase in referrals of patients with HIV-associated TB to this ART service, a progressive decline in referral delay, improvements in baseline CD4 cell counts, and fewer recurrent TB episodes. Such trends are likely to be associated with improved survival, and these data strongly support this HIV-testing strategy.