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Likelihood that a Visit to a Comprehensive HIV Clinic will Result in Diagnosis of Tuberculosis Co-Infection After First 3 Months of Implementation in Kono, Sierra Leone
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A6105 - Likelihood that a Visit to a Comprehensive HIV Clinic will Result in Diagnosis of Tuberculosis Co-Infection After First 3 Months of Implementation in Kono, Sierra Leone
Author Block: K. Kongpakpaisarn1, S. Hudey1, F. Bangura2, J. M. Sesay2, A. S. Fillie2, A. Kannessie2, A. Oxner1; 1Internal Medicine, University of South Florida, Tampa, FL, United States, 2Koidu Government Hospital, Ministry of Health and Sanitation, Kono, Sierra Leone.
Rationale: Due to shortages in trained human resources for health in Sierra Leone, task shifting of clinical care has occurred to allied personnel called HIV/TB counselors. Koidu Government Hospital (KGH) is a 300-bed referral hospital in Kono, Sierra Leone serving a catchment population of 250,000 and caring for all the complicated HIV and TB patients in the district including inpatient services. This study analyzes clinically significant changes in HIV treatment and rates of diagnosis of TB co-infection for a population of 188 HIV-infected patients during a pilot comprehensive HIV clinic at KGH.
Methods: We established a comprehensive HIV clinic at KGH staffed by healthcare professionals including medical doctors, HIV counselors, and community health workers (CHWs) in June 2016. The HIV clinic was offered to all patients who were followed at KGH; accounting for 43% of known patients in the district. The clinical services offered were: group education about HIV, vital signs with BMI, medication review including side effects and barriers, physical exam, evaluation for opportunistic infections and appropriate chemoprophylaxis, phlebotomy for CD4 testing, medication refill, and screening for tuberculosis symptoms with sputum collection on-site if the screening was positive. Sputum was tested using the GeneXpert MTB/RIF platform. The data analyzed is pooled, deidentified data from the first 3 months of implementation June 1, 2016 to August 30, 2016. The data collection method, storage, and analysis have been approved by institutional board review (IRB) of University of South Florida and Sierra Leone Ethics and Scientific Review Committee.
Results: Out of 188 unique patients that were seen by the healthcare team, 49 patients’ HIV medication regimens were changed (26% of total). Of those, 38 patient regimens changed due to new diagnosis of co-infection with pulmonary tuberculosis—which signifies that 20% of the total patients had untreated tuberculosis. The remaining patients’ regimens were changed because of weight-based dosing for pediatric patients (5 patients) or immunologic ART failure based on CD4 count (6 patients). The reasons for testing sputum in the 38 patients diagnosed with TB co-infection were: BMI below 18.5 (17 patients), CD4 below 500 and history of exposure (15 patients), or both low BMI and low CD4 (6 patients).
Conclusion: A comprehensive HIV clinic can contribute to significant changes in HIV care and high rates of case finding for tuberculosis without adding lab capacity beyond CD4 and MTB/RIF testing.
Author Block: K. Kongpakpaisarn1, S. Hudey1, F. Bangura2, J. M. Sesay2, A. S. Fillie2, A. Kannessie2, A. Oxner1; 1Internal Medicine, University of South Florida, Tampa, FL, United States, 2Koidu Government Hospital, Ministry of Health and Sanitation, Kono, Sierra Leone.
Rationale: Due to shortages in trained human resources for health in Sierra Leone, task shifting of clinical care has occurred to allied personnel called HIV/TB counselors. Koidu Government Hospital (KGH) is a 300-bed referral hospital in Kono, Sierra Leone serving a catchment population of 250,000 and caring for all the complicated HIV and TB patients in the district including inpatient services. This study analyzes clinically significant changes in HIV treatment and rates of diagnosis of TB co-infection for a population of 188 HIV-infected patients during a pilot comprehensive HIV clinic at KGH.
Methods: We established a comprehensive HIV clinic at KGH staffed by healthcare professionals including medical doctors, HIV counselors, and community health workers (CHWs) in June 2016. The HIV clinic was offered to all patients who were followed at KGH; accounting for 43% of known patients in the district. The clinical services offered were: group education about HIV, vital signs with BMI, medication review including side effects and barriers, physical exam, evaluation for opportunistic infections and appropriate chemoprophylaxis, phlebotomy for CD4 testing, medication refill, and screening for tuberculosis symptoms with sputum collection on-site if the screening was positive. Sputum was tested using the GeneXpert MTB/RIF platform. The data analyzed is pooled, deidentified data from the first 3 months of implementation June 1, 2016 to August 30, 2016. The data collection method, storage, and analysis have been approved by institutional board review (IRB) of University of South Florida and Sierra Leone Ethics and Scientific Review Committee.
Results: Out of 188 unique patients that were seen by the healthcare team, 49 patients’ HIV medication regimens were changed (26% of total). Of those, 38 patient regimens changed due to new diagnosis of co-infection with pulmonary tuberculosis—which signifies that 20% of the total patients had untreated tuberculosis. The remaining patients’ regimens were changed because of weight-based dosing for pediatric patients (5 patients) or immunologic ART failure based on CD4 count (6 patients). The reasons for testing sputum in the 38 patients diagnosed with TB co-infection were: BMI below 18.5 (17 patients), CD4 below 500 and history of exposure (15 patients), or both low BMI and low CD4 (6 patients).
Conclusion: A comprehensive HIV clinic can contribute to significant changes in HIV care and high rates of case finding for tuberculosis without adding lab capacity beyond CD4 and MTB/RIF testing.
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