Low HIV testing rates among tuberculosis patients in Kampala, Uganda
- Equal contributors
1 Kampala City Council, Public Health Department, P. O. Box 700, Kampala, Uganda
2 Erasmus Medical Centre, Department of Virology, 3000 CA Rotterdam, The Netherlands
3 Academic Medical Centre, Amsterdam, Center for Poverty-related Communicable Diseases, 1105 AZ, Amsterdam, The Netherlands
4 Amsterdam Institute for Global Health and Development. P. O. Box 22700, Amsterdam, The Netherlands
5 KNCV Tuberculosis Foundation, 2501 CC, The Hague, The Netherlands
6 Makerere University School of Public Health, P. O. Box 7072, Kampala, Uganda
BMC Public Health 2010, 10:177 doi:10.1186/1471-2458-10-177Published: 31 March 2010
HIV testing among tuberculosis patients is critical in improving morbidity and mortality as those found to be HIV positive will be offered a continuum of care including ART if indicated. We conducted a cross-sectional study in three Kampala City primary care clinics: to assess the level of HIV test uptake among newly diagnosed pulmonary tuberculosis (PTB) patients; to assess patient and health worker factors associated with HIV test uptake; and to determine factors associated with HIV test uptake at the primary care clinics
Adult patients who had been diagnosed with smear-positive PTB at a primary care clinic or at the referral hospital and who were being treated at any of the three clinics were interviewed. Associations between having taken the test as the main outcome and explanatory variables were assessed by multivariate logistic regression.
Between April and October 2007, 112 adults were included in the study. An HIV test had been offered to 74 (66%). Of the 112 patients, 61 (82%) had accepted the test; 45 (74%) had eventually been tested; and 32 (29%) had received their test results.
Patients who were <25 yeas old, female or unemployed, or had reported no previous HIV testing, were more likely to have been tested. The strongest predictor of having been tested was if patients had been diagnosed at the referral hospital compared to the city clinic (adjusted OR 24.2; 95% CI 6.7-87.7; p < 0.001). This primarily reflected an "opt-out" (uptake 94%) versus an "opt-in" (uptake 53%) testing policy.
The overall HIV test uptake was surprisingly low at 40%. The HIV test uptake was significantly higher among TB patients who were identified at hospital, among females and in the unemployed.