Linkage to TB and HIV care for persons who smoke illicit drugs: a prospective cohort study.

BACKGROUND: Linking people diagnosed with TB and HIV into care is critical. However, many barriers exist to care linkage, especially for people who use drugs (PWUD).

OBJECTIVES: Characterise differences in TB and HIV care linkage among PWUD in a high-TB/HIV-burden setting.

DESIGN: We analysed HIV and TB linkage to care among PWUD who were diagnosed with HIV and/or TB in a prospective study in Worcester, South Africa. We compared care cascades between participants diagnosed with HIV, TB, or both.

RESULTS: Among 750 participants screened in the community for HIV and TB, we diagnosed and referred 81 individuals with newly diagnosed (N = 39) or previously diagnosed but untreated (N = 42) HIV, as well as 64 individuals with newly diagnosed TB; 11 of these individuals had HIV/TB co-infection. Linkage was higher for TB care (78%) than HIV care (57% for previously diagnosed and 42% for newly diagnosed). 56% of participants with TB had a favourable treatment outcome, whereas only 23% of people with HIV were retained on antiretroviral therapy 6 months after referral.

CONCLUSION: While many PWUD successfully linked to TB and HIV care, disparities exist between the two cascades in this setting. Systems improvements are needed to facilitate linkage and retention for high-risk populations.