Evaluation of the implementation of tuberculosis (TB) intensified case finding (ICF) among HIV- infected patients in Ho Chi Minh City and Hanoi, Vietnam Pubblico
Trinh, Thuy Thi Thanh (2012)
Published
Abstract
Background: In order to reduce the burden of tuberculosis among
people living with HIV
(PLHIV) the World Health Organization (WHO) recommended intensified
case finding
as a key component of the 3 I's initiative. In 2007, the Vietnam
Ministry of Health issued
national guidelines on TB diagnosis on PLHIV.
Objectives: To define the quality and coverage of ICF for PLHIV and
identify any
barriers to ICF among PLHIV attending HIV care in antiretroviral
treatment clinics in
Hanoi and HCMC.
Method: Retrospective cohort study designed to collect data from
adult HIV-infected
patients in 5 out- patient clinics. Data was abstracted from
patient's chart regarding TB
screening in outpatient clinics OPC and TB diagnosis in TB clinics.
A qualitative analysis
was conducted to understand ICF practices and associated factors
among health care staff
in these clinics.
Results: Among 489 eligible patients, 461 (94%) were screened for
TB every year. Nine
percent of the screened patients in the last visit had one of 3
symptoms (cough, fever,
weight loss) and 56% of them were referred to TB clinics to rule
out active TB. All of
those referred had sputum smears done and 42% had chest x-ray done.
There was no
association between being screened for 3 symptoms and age group,
HIV transmission
routes and ART status. Interviews with healthcare workers (HCW)
suggested that HIV-
infected patients should be screened for cough, fever, weight loss
and night sweats and
that screening should be done at all visits. HCW indentified
barriers for ICF including the
fact that TB and HIV services were sometimes not offered at the
same location, that
patients needed to travel multiple times for TB diagnosis without
transportation support,
and that patients were at times too sick to travel.
Discussion: Although, health care workers knew that HIV patients
should be screened for
TB at every visit and that they should be screening for cough,
fever, weight loss and/or
night sweat, TB-symptom screening was not consistent and 6% of
patients had never
been screened for TB. Healthcare workers should have more training
on the national and
WHO guidelines on ICF.
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