Rate of new cases of TB diagnosed in clients attending HIV testing and counselling services or HIV treatment and care services

Export Indicator

Percent of cases of newly dianosed TB identified in PLWHA attending for HIV testing and counselling or HIV treatment and care services (who were screened for TB symptoms)
What it measures

To provide information on the output of intensified TB case-finding and demonstrate the additional cases of TB detected through collaborative TB/HIV activities.

Rationale
Numerator

The number of cases of newly diagnosed TB identified in PLWHA attending for HIV testing and counselling or HIV treatment and care services who were screened for TB symptoms, over a given time period

Denominator

Total number of PLWHA attending for HIV testing and counselling or HIV treatment and care services who were screened for TB symptoms over the same given time period.

Calculation
Method of measurement

All HIV-positive clients at HIV testing and counselling facilities or those attending HIV treatment and care facilities should undergo intensified case-finding for TB as described in indicator B.1.1, Intensified case finding amoun PLWHA. Any client found to be a TB suspect through this screening process should be investigated further, either on site or after referral to the nearest TB clinic. NTP criteria should be used to define a TB suspect and for diagnosing TB. The number of newly diagnosed cases of TB in HIV-positive clients by this process should be collated. The data needed for this indicator will be routinely collected at the HIV testing and counselling or treatment and care facilities if these are capable of TB diagnosis. Otherwise, a referral system will need to be established which ensures that TB suspects are referred to the nearest TB clinic for investigation; the outcome of investigation should then be communicated back to the HIV testing and counselling or treatment and care facility.

Measurement frequency

Continuously

Disaggregation

Condom type: N/A

Education: N/A

Gender: N/A

Geographic location: N/A

HIV status: N/A

Pregnancy status: N/A

Sector: N/A

Service Type: N/A

Target: N/A

Time period: N/A

Type of orphan: N/A

Type/Timing of testing: N/A

Vulnerability status: N/A

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

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.

Further information