AUTHOR=Maokola Werner , Ngowi Bernard , Lawson Lovetti , Mahande Michael , Todd Jim , Msuya Sia E. 

TITLE=Performance of and Factors Associated With Tuberculosis Screening and Diagnosis Among People Living With HIV: Analysis of 2012–2016 Routine HIV Data in Tanzania

JOURNAL=Frontiers in Public Health

VOLUME=Volume 7 - 2019

YEAR=2020

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2019.00404

DOI=10.3389/fpubh.2019.00404

ISSN=2296-2565

ABSTRACT=All persons living with HIV (PLHIV) attending HIV care and treatment clinics (CTC) should be screened for TB at every visit and those positive on screening should be given diagnostic investigations.
We evaluated the performance of the TB diagnosis cascade among PLHIV attending CTC between January 2012 and December 2016, in three regions of Tanzania, Dar es Salaam, Iringa and Njombe. We used logistic regression to determine odds ratios (OR) for factors associated with TB screening and the use of appropriate TB diagnostic methods at these clinic visits.
We analyzed 169,741 PLHIV who made 2,638,876 visits to CTC between January 2012 and December 2016.  We excluded 2,074 (0.1%) visits as these involved patients enrolled in CTC with a prior TB disease diagnosis. Of the 2,636,802 visits, 2,524,494 (95.7%) had TB screening according to national guidelines, of which 60,796 (2.4%) had TB screening positive results. Of the 60,796 visits with a positive TB screening, further investigation for TB was as follows: sputum microscopy examination; 22,825 (37.5%), Chest Xray; 9,369 (15.4%) clinical diagnosis; 27,578 (45.4%) and unknown method; 1,24 (1.7%). 
In multivariate logistic regression analysis, TB screening was more likely among females than males (OR=1.30, 95% CI: 1.27-1.32, P<0.001), 2016 enrolment year compared to early years (OR=1.26, 95% CI 1.21-1.32, P<0.001), in the first visit compared to subsequent visits (OR=1.48, 95% CI 1.43-1.53, P<0.001) and in Njombe region (OR=2.38; 95% CI 2.28-2.48, P<0.001) compared to other regions. TB screening was less likely among those with WHO clinical stage 1; (OR=0.54, 95% CI 0.52-0.57, P<0.001), those attending private health facilities (OR=0.46, 95% CI: 0.45-0.47, P<0.001). 
Multivariate logistic regression analysis for TB diagnostic methods, health facility ownership and Iringa region were statistically significant in diagnosing TB using sputum examination; OR=2.03, 95%CI:1.80-2.28, P<0.001 and OR=5.32, 95% CI: 4.26-6.66, P<0.001 respectively.
In more than 95% of the visits to CTC PLHIV were screened for TB.  This needs to be supplemented with quality improvement along the diagnosis cascade to improve TB case diagnosis and TB diagnosis using sputum examination which is a standard of care in Tanzania.