Integrated Tuberculosis/Human Immunodeficiency Virus Community-Based Case Finding in Rural South Africa: Implications for Tuberculosis Control Efforts

Shenoi, Sheela; Moll, Anthony; Brooks, Ralph; Kyriakides, Tassos C.; Andrews, Laurie; Kompala, T; Upadhya, Devesh; Altice, Frederick L.; Eksteen, Francois; Friedland, Gerald

doi:10.1093/ofid/ofx092

Cited by 16 publications

(27 citation statements)

References 29 publications

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“…We addressed this by also accessing the Department of Health TB Control Programme and National Health Laboratory Services, which are not clinic-specific. Additionally, incorporating GeneXpert MTB/RIF testing in the community posed logistical challenges; as seen in other studies in KwaZulu-Natal, many eligible participants were not able to produce sputum on the mobile unit, which may have restricted the yield of new TB cases [23]. Participants may have also felt inhibited to produce sputum in community venues.…”

Section: Discussionmentioning

confidence: 99%

Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South Africa

et al. 2019

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BackgroundCommunity-based GeneXpert MTB/RIF testing may increase detection of prevalent TB in the community and improve rates of TB treatment completion.MethodsWe conducted a pilot randomized trial to evaluate the impact of GeneXpert screening on a mobile HIV testing unit. Adults (≥18y) underwent rapid HIV testing and TB symptom screening and were randomized to usual mobile unit care (providing sputum on the mobile unit sent out for GeneXpert testing) or the “Test & Treat TB” intervention with immediate GeneXpert testing. Symptomatic participants in usual care produced sputum that was sent for hospital-based GeneXpert testing; participants were contacted ~ 7 days later with results. In the “Test & Treat TB” intervention, HIV-infected or HIV-uninfected/TB symptomatic participants underwent GeneXpert testing on the mobile unit. GeneXpert+ participants received expedited TB treatment initiation, monthly SMS reminders and non-cash incentives. We assessed 6-month TB treatment outcomes.Results4815 were eligible and enrolled; median age was 27 years (IQR 22 to 35). TB symptoms included cough (5%), weight loss (4%), night sweats (4%), and fever (3%). 42% of eligible participants produced sputum (intervention: 56%; usual care: 26%). Seven participants tested GeneXpert+, six in the intervention (3%, 95% CI 1%, 5%) and one in usual care (1%, 95% CI 0%, 6%). 5 of 6 intervention participants completed TB treatment; the GeneXpert+ participant in usual care did not.ConclusionGeneXpert MTB/RIF screening on a mobile HIV testing unit is feasible. Yield for GeneXpert+ TB was low, however, the “Test & Treat TB” strategy led to high rates of TB treatment completion.Trial registrationThis study was registered on November 21, 2014 at ClinicalTrials.gov (NCT02298309).

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Section: Discussionmentioning

confidence: 99%

Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South Africa

et al. 2019

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“…Identifying persons with symptoms and signs of TB, and the start of a medical evaluation as early as possible, could avoid the lengthy process and unnecessary delays. In addition, an innovative TB screening approach, such as screening any patient with a cough of any duration with at least one of the suggestive TB symptoms present, should be considered to improve TB case finding [64]. An integrated intensive case finding of TB, not only for HIV-infected individuals but also for patients with diabetic and cardiac problems, as well as maternal and child health clinics, could improve TB case finding [65].…”

Section: Implications For Practicementioning

confidence: 99%

Barriers for tuberculosis case finding in Southwest Ethiopia: A qualitative study

et al. 2020

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Background Ethiopia is one of the countries with a high burden of tuberculosis (TB). Jimma Zone has the lowest TB case notification rate compared to the national and World Health Organization's (WHO) targets. The aim of the present study was to identify barriers, and explore the origin of these barriers in relation to TB case finding. Methods A qualitative study was conducted by using different data collection methods and sources. Sixty in-depth interviews with TB treatment providers, program managers and TB patients were included. In addition, 42 governmental health facilities were observed for availability of resources. Data obtained from the in-depth interviews were transcribed, coded, categorized and thematized. Atlas.ti version 7.1 software was used for the data coding and categorizing. Results Inadequate resources for TB case finding, such as a shortage of health-care providers, inadequate basic infrastructure, and inadequate diagnostic equipment and supplies, as well as limited access to TB diagnostic services such as an absence of nearby health facilities providing TB diagnostic services and health system delays in the diagnostic process, were identified as barriers for TB case finding. We identified the absence of trained laboratory professionals in 11, the absence of clean water supply in 13 and the electricity in seven health facilities. Furthermore, we found that difficult topography, the absence of proper roads, an inadequate collaboration with other sectors (such as education), a turnover of laboratory professionals, and a low community mobilization, as the origin of some of these barriers.

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“…20 A team of trained community health workers provided health education, counseling, and offered voluntary and confidential private HIV testing in community-based settings. 21 No monetary incentives were given for participation. The survey was administered verbally by trained male interviewers in isiZulu, and responses were recorded electronically on handheld tablets.…”

Section: Methodsmentioning

confidence: 99%

Mobile Device Usage by Gender Among High-Risk HIV Individuals in a Rural, Resource-Limited Setting

Campbell

Choi

Neils

et al. 2021

Telemedicine and e-Health

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Background: Mobile health (mHealth) is a promising tool to deliver healthcare interventions to underserved populations. We characterized the use of mobile devices in rural KwaZulu-Natal, South Africa to tailor mHealth interventions for people living with HIV and at risk for acquiring HIV in the middle-income country. Methods: We surveyed participants in community settings and offered free HIV counseling and testing. Participants selfreported their gender, age, relationship, and employment status, receipt of monthly grant, condomless sex frequency, and circumcision status (if male). Outcomes included cell phone and smartphone ownership, private data access, health information seeking, and willingness to receive healthcare messages. We performed multivariable logistic regression to assess the relationship between demographic factors and outcomes. Results: Although only 10% of the 788 individuals surveyed used the phone to seek health information, 93% of cell phone owners were willing to receive healthcare messages. Being young, female, employed, and in a relationship were associated with cell phone ownership. Smartphone owners were more likely to be young, female, and employed. Participants reporting condomless sex or lack of circumcision were significantly less likely to have private data access or to purchase data. Conclusions: mHealth interventions should be feasible in rural KwaZulu-Natal, though differ by gender. As women are more likely to own smartphones, smartphone-based mHealth interventions specifically geared to prevent the acquisition of or to support the care of HIV in young women in KwaZulu-Natal may be feasible. mHealth interventions encouraging condom use and medical male circumcision should consider the use of nonsmartphone short message service and be attuned to mobile data limitations-especially when targeting men.

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Integrated Tuberculosis/Human Immunodeficiency Virus Community-Based Case Finding in Rural South Africa: Implications for Tuberculosis Control Efforts

Cited by 16 publications

References 29 publications

Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South Africa

Test and Treat TB: a pilot trial of GeneXpert MTB/RIF screening on a mobile HIV testing unit in South Africa

Barriers for tuberculosis case finding in Southwest Ethiopia: A qualitative study

Mobile Device Usage by Gender Among High-Risk HIV Individuals in a Rural, Resource-Limited Setting

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