How Well Does The Process Of Screening And Diagnosis Work For Hiv- Infected Persons Identified With Presumptive Tuberculosis Who Are Attending Hiv Care And Treatment Clinics In Harare City, Zimbabwe?

Background: Intensified TB case finding is recommended for all HIV-infected persons regularly attending HIV care and treatment clinics. The authors aimed to determine how well this system worked among HIV-infected patients diagnosed with presumptive TB in 14 health facilities of Harare province, Zimbabwe, between January and December 2016.Methods: Retrospective review using routine programme records.Results: Of 47 659 HIV-infected persons enrolled in HIV care, 102 were identified with presumptive TB through the programmatic electronic database. Of these, 23% (23/102) were recorded in presumptive TB registers and, of these 65% (15/23) were traced to Laboratory registers. Of 79 patients not recorded in presumptive TB registers, 9% (7/79) were traced to Laboratory registers. Of 22 patients in the Laboratory register, all had negative sputum smears for acid-fast bacilli and 45% (10/22) had Xpert MTB/RIF assays with one positive result. Six patients altogether started anti-tuberculosis treatment, the median time from presumptive tuberculosis diagnosis to treatment being 12 days. The only significant risk factor for Loss-to-follow-up between presumptive TB diagnosis and Laboratory registration was not being recorded in presumptive TB registers.Conclusions: Follow-up mechanisms for presumptive TB cases diagnosed in HIV care clinics in Harare city need strengthening, particularly through improved documentation in presumptive TB registers and better Xpert MTB/RIF use.