在印度南部两个地区的结核病控制规划下，医务人员为结核病患者提供艾滋病病毒检测和咨询服务的可行性。
Feasibility of provider-initiated HIV testing and counselling of tuberculosis patients under the TB control programme in two districts of South India.
机构信息
National Tuberculosis Institute, Bangalore, India.
出版信息
PLoS One. 2009 Nov 19;4(11):e7899. doi: 10.1371/journal.pone.0007899.
BACKGROUND
Provider-initiated HIV testing and counselling (PITC) is internationally recommended for tuberculosis (TB) patients, but the feasibility, effectiveness, and impact of this policy on the TB programme in India are unknown. We evaluated PITC of TB patients across two districts in India considered to have generalized HIV epidemics, Tiruchirappalli (population 2.5 million) and Mysore (population 2.8 million).
METHODOLOGY/PRINCIPAL FINDINGS: Starting June 2007, healthcare providers in both districts were instructed to ascertain HIV status for all TB patients, and refer those with unknown HIV status to the nearest Integrated Counselling and Testing Centre (ICTC)--often in the same facility--for counselling and voluntary HIV testing. All TB patients registered from June 2007 to March 2008 were followed prospectively. Field investigators assessed PITC practices and abstracted data from routine TB programme records and HIV counselling registers to determine the proportion of TB patients appropriately evaluated for HIV infection. Patient records were traced to determine the efficiency of referral links to HIV care and antiretroviral treatment (ART). Between July 2007 and March 2008, 5299 TB patients were registered in both study districts. Of the 4701 with unknown HIV status at the time of TB treatment initiation, 3368 (72%) were referred to an ICTC, and 3111 (66%) were newly tested for HIV. PITC implementation resulted in the ascertainment of HIV status for 3709/5299 (70%) of TB patients, and detected 200 cases with previously undiagnosed HIV infection. Overall, 468 (8.8%) of all registered TB patients were HIV-infected; 177 (37%) were documented to have also received any ART.
CONCLUSIONS
With implementation of PITC in India, HIV status was successfully ascertained for 70% of TB patients. Previously undiagnosed HIV-infection was detected in 6.4% of those TB patients newly tested, enabling referral for life-saving anti-retroviral treatment. ART uptake, however, was poor, suggesting that PITC implementation should include measures to strengthen and support ART referral, evaluation, and initiation.
背景
国际上建议在结核病（TB）患者中进行医务人员主导的 HIV 检测和咨询（PITC），但该政策在印度结核病规划中的可行性、效果和影响尚不清楚。我们评估了在被认为存在广泛 HIV 流行的印度两个地区（Tiruchirappalli[人口 250 万]和 Mysore[人口 280 万]）的结核病患者中开展 PITC 的情况。
方法/主要发现：从 2007 年 6 月开始，两个地区的医疗保健提供者被指示对所有结核病患者进行 HIV 检测，并将那些 HIV 检测结果未知的患者转介到最近的艾滋病综合咨询检测中心（通常在同一设施内）进行咨询和自愿 HIV 检测。从 2007 年 6 月至 2008 年 3 月期间，所有新登记的结核病患者都进行了前瞻性随访。现场调查员评估了 PITC 的实施情况，并从结核病规划常规记录和艾滋病毒咨询登记册中提取数据，以确定对 HIV 感染进行适当评估的结核病患者的比例。追查患者记录，以确定向艾滋病毒护理和抗逆转录病毒治疗（ART）转介的效率。在 2007 年 7 月至 2008 年 3 月期间，两个研究地区共登记了 5299 例结核病患者。在开始结核病治疗时 HIV 检测结果未知的 4701 例患者中，有 3368 例（72%）被转介到艾滋病综合咨询检测中心，有 3111 例（66%）接受了新的 HIV 检测。实施 PITC 后，5299 例结核病患者中有 3709 例（70%）确定了 HIV 状况，并发现了 200 例以前未确诊的 HIV 感染病例。总的来说，所有登记的结核病患者中，有 468 例（8.8%）感染了 HIV；其中 177 例（37%）有记录表明还接受了任何 ART。
结论
在印度实施 PITC 后，成功地对 70%的结核病患者确定了 HIV 状况。在新接受检测的结核病患者中，有 6.4%发现了以前未确诊的 HIV 感染，这使他们能够获得挽救生命的抗逆转录病毒治疗。然而，ART 的接受率很低，这表明实施 PITC 应包括加强和支持 ART 转介、评估和启动的措施。
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