Intensified TB case-finding among PLWHA
This is a process indicator for an activity intended to reduce the impact of TB among PLWHA. It will demonstrate the level of implementation of the recommendation that PLWHA are screened for TB at diagnosis and at all follow-up visits.
Number of PLWHA attending for HIV testing and counselling or HIV treatment and care services who were screened for TB symptoms, over a given time period
Total number of PLWHA attending for HIV testing and counselling or HIV treatment and care services, over the same given time period
Data should be collected routinely at all HIV testing and counselling facilities (e.g. VCT centres, PMTCT providers, medical inpatient wards, private sector) and any situation where regular HIV care and support are provided (e.g. ART clinics, HIV care clinics, PWLHA support groups). A suggested method of conducting the screening would be to ask HIV-positive clients whether they are currently on TB treatment. If not, they would then be asked about the key symptoms of TB disease (e.g. cough, fever, night sweats, recent weight loss, lymphadenopathy). A simple checklist could be used and any positive response would indicate that the individual should be managed as a TB suspect. TB control programme protocols should define the criteria for identifying a TB suspect. TB suspects should not be given treatment of latent TB infection and should be investigated for TB (or referred to TB service for investigation). This can be reported as a total or separately by facility type for each situation in which HIV care and support are provided or HIV counselling and testing are conducted, e.g. number of HIV positive clients newly diagnosed at VCT centre or number of HIV-positive clients who attend for annual check-up who are screened for TB symptoms.
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There are two reasons for carrying out TB screening among PLWHA. Firstly, incidence of TB is greatly increased in PLWHA and identification of those with symptoms of TB is the first step in active case-finding. Early identification of TB suspects with signs and symptoms of TB, followed by prompt referral for diagnosis and treatment, increases the chances of survival, improves quality of life and reduces transmission of TB in the community. Secondly, TB symptom screening can also form the basis for identifying HIV-positive clients who show no evidence of active TB and would benefit from treatment with isoniazid for latent TB infection. In some settings, exclusion of active TB will also include a tuberculin skin test and/or chest X-ray. Collection of these data by all levels of staff involved in HIV testing and counselling or HIV treatment and care is simple. The indicator does not measure the quality of intensified TB casefinding nor does it reveal whether those identified as suspects are investigated further or effectively for TB. However, it does emphasize the importance of intensified TB case-finding for PLWHA at diagnosis and at every contact they have with HIV treatment and care services. Programmes should aim for a high value for this indicator (close to 100%) but should interpret it in conjunction with values of indicators B.1.2, Rate of new cases of TB diagnosed in clients attending HIV testing and counselling services or HIV treatment and care services, and B.2.1, Proportion of HIV-positive clients given treatment for latent TB infection to ensure that appropriate action follows the screening process. A low value will demonstrate that Objective B - reducing the impact of TB among PLWHA - is unlikely to be met.