Screening and testing for tuberculosis among the HIV-infected: outcomes from a large HIV programme in western Kenya

Background People living with HIV (PLHIV) are at increased risk of tuberculosis (TB). TB is also the leading opportunistic infection contributing to about one-third of deaths in this population. The World Health Organization recommends regular screening for TB in PLHIV. Those identified to have any TB-related symptoms are investigated and treated if diagnosed with TB. We sought to evaluate outcomes of intensified case finding and factors associated with undesirable screening for TB in a large HIV programme in western Kenya. Methods We conducted a retrospective study using routine programme data from the AMPATH HIV electronic medical records database for PLHIV in care between 2015 and 2016. Screening for TB was assessed by the recorded presence of cough ≥2 weeks, fever, night sweats, unintentional weight loss, chest pain and/or breathlessness. Undesirable screening was defined as being screened in Results There were 90,454 PLHIV, 65% females, median age 40 years, median follow-up time of 1.5 years. Total encounters were 683,898, of which screening for TB was recorded in 87%. 1424 (1.6%) PLHIV were not screened at all during the study period. 44% (95% CI: 43.6-44.3) of PLHIV were screened in Conclusions There were missed opportunities for screening and testing for TB. Screening was reduced by being on ART, having increased patient-encounters, the clinic setup, and by high patient volumes. HIV programmes should focus on quality of TB care in HIV clinics.