Background: HPTN 071 (PopART) is a community-randomised trial of a combination HIV prevention intervention, which includes home-based HIV counselling and testing and tuberculosis (TB) screening, delivered in four annual rounds by Community HIV-care Providers (CHiPs) in Zambia and South Africa. We evaluated the feasibility, uptake and yield of household-based TB active case finding (ACF) within a combination HIV prevention intervention.
Methods: We report data from the second annual round (06/2015-08/2016) from six South African communities. Adults (≥18 years) that consented to participate were eligible for TB screening if not on TB treatment. CHiPs administered electronic TB screening questionnaires (weight loss, cough ≥2 weeks, night sweats) and enquired about persons with TB in the household or at work. Two sputum specimens were collected from adults with presumptive TB (≥1 symptom or in contact with TB). Diagnosis of bacteriologically confirmed pulmonary TB (PTB) was based on Xpert MTB/RIF®, smear microscopy, or culture. PTB cases were referred to the local health care facility for treatment. Multivariable logistic regression was used to determine the association of sex and age with different outcomes within the TB cascade of care.
Results: 103,455 adults were eligible for TB screening. 101,630/103,455 (98%) adults received TB screening (43% males, median age 31 years). 2,709/101,630 (3%) were presumptive TB cases. 2,263/2,709 (84%) were followed up. 167/2,263 (7%) were PTB cases. 143/167 (86%) initiated TB treatment (See Figure 1). Adults aged ≥55 were more likely to be presumptive TB cases compared to younger age groups (P-value< 0.01). Females were less likely to be presumptive TB cases (aOR 0.78, 95%CI 0.72-0.84) and less likely to be diagnosed with PTB (aOR 0.67, 95%CI 0.49-0.93) compared to males.

Figure 1: Flowchart for TB active case finding
[Figure 1: Flowchart for TB active case finding]

Conclusions: ACF through household TB screening within a combination HIV prevention intervention is feasible. CHiPs were able to identify undiagnosed cases in the community and refer adults for treatment.

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