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Home / Public Health Action, Volume 5, Number 4

Open Access Are HIV-positive presumptive tuberculosis patients without tuberculosis getting the care they need in Zimbabwe?

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Setting: Emakhandeni Clinic provides decentralised and integrated tuberculosis (TB) and human immunodeficiency virus (HIV) care in Bulawayo, Zimbabwe.

Objectives: To compare HIV care for presumptive TB patients with and without TB registered in 2013.

Design: Retrospective cohort study using routine programme data.

Results: Of 422 registered presumptive TB patients, 26% were already known to be HIV-positive. Among the remaining 315 patients, 255 (81%) were tested for HIV, of whom 190 (75%) tested HIV-positive. Of these, 26% were diagnosed with TB and 71% without TB (3% had no TB result recorded). For the 134 patients without TB, antiretroviral treatment (ART) eligibility data were recorded for 42 (31%); 95% of these were ART eligible. Initiation of cotrimoxazole preventive therapy (CPT) and ART was recorded for respectively 88% and 90% of HIV-positive patients with TB compared with respectively 40% and 38% of HIV-positive patients without TB (P < 0.001).

Conclusion: Presumptive TB patients without TB had a high HIV positivity rate and, for those with available data, most were ART eligible. Unlike HIV-positive patients diagnosed with TB, CPT and ART uptake for these patients was poor. A ‘test and treat’ approach and better service linkages could be life-saving for these patients, especially in southern Africa, where there are high burdens of HIV and TB.

Keywords: SORT IT; antiretroviral treatment; operational research; sub-Saharan Africa

Document Type: Research Article

Affiliations: 1: International Union Against Tuberculosis and Lung Disease, Bulawayo, Zimbabwe 2: Health Services Department, City of Bulawayo, Bulawayo, Zimbabwe 3: International Union Against Tuberculosis and Lung Disease, Bulawayo, Zimbabwe, AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe 4: Médecins Sans Frontières, Operational Centre Brussels, Operational Research Unit, MSF-Luxembourg, Luxembourg 5: International Union Against Tuberculosis and Lung Disease, Bulawayo, Zimbabwe, London School of Hygiene & Tropical Medicine, London, UK

Publication date: 21 December 2015

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  • Public Health Action (PHA), The Union's quarterly Open Access journal, welcomes the submission of articles on operational research. It publishes high-quality scientific research on health services, providing new knowledge on how to improve access, equity, quality and efficiency of health systems and services.

    The Editors will consider any manuscript reporting original research on quality improvements, cost-benefit analysis, legislation, training and capacity building, with a focus on all relevant areas of public health (e.g. infection control, nutrition, TB, HIV, vaccines, smoking, COVID-19, microbial resistance, outbreaks etc).

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