Assessment of TB Screening and Referral Linkage among HIV Patients Attending ART Clinic of Butajira Hospital, SNNPR, Ethiopia
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Date
2010-06-01
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Addis Ababa University
Abstract
Background: Tuberculosis (TB) screening recommended [or people living with human iminunodeficiency virus (PLWHA) to facilitate early diagnosis and safe initiation of antiretrc viral therapy (ART) and Ionized preventive therapy (lPT). The interaction between TB and r-II ! infection is complex. HIV :infect on weakens the immune system and increases the susceptibility to TB. I-TIV increases the likelihood of reactivate on, re- infection and progression of tattle TB infection to active disease.
Objectives: The aim of this study was to assess TB screening and referral linkage among HIV patients attending ART clinic of Butajira hospital.
Methods: PL WH ~ who were enrolled in the lime priced from 1998 - 200 I E.C studied. Both quantitative and qualitative data collection methods were used to conduct the study. A total of 384 patient's charts that fulfill the inclusion _ criteria were select d by systematic random sampling technique for cross sectional stud y. For qua1itative study, by purposive sampling, 10 healthcare providers and program coordinators were interviewed to complement to the quantitative study. By purposive bivariate and multivariate ate analysis were used to determine the factors associated with TB diagnosis. The qualitative data were analyzed thematically.
Result: Among the screened PLWHA, 97 (2 5.3%) were on INH and 224 (58.3%) of patients Were co-trimoxazole prophylactic therapy (CPT). Out of evaluated PL WHA 300 (78.1 %) were screened for TB d There was no TB screening for VCT clients who were tested I HIV positive at V T clinic. TPT & CPT were not provided for all eligible PLWHA. The referral linkages or HIV patients to ART clinic with intra-facility and inter-facility were through referral lips; however most of patient's referral slips were not documented. Routine TS screening for all VCT clients who are tested HIV positive is recommended to be screened at VCT clinic. I PT & CPT wail be provided for all eligible PLWIIA according to FMOH TB/HIV Implementation on guidelines. TS/HIV technical cOlm.1ittce en-IT ) at Hosp ital, Zonal and Regional level should be re-organized and strengthen according to national TB/HIV guidelines. Periodic evaluate on of TS and HIV programmers should be strengthen at all level. Regular supportive supervision, bi-annually and annually at program management level is recommended. t least one time and 84 (21.9 %), were never screened for TB. Active TB'. I was diagnosed in 69 (23%) patients; of which 20 (29%), 33 (47.8%), and 16 (23.2%) of cases were smear positive pulmonary TB, pulmonary negate and extra-pulmonary TB, respectively.
There were significant association between TB case finding versus cough, dispend, chronic fatigue, night sweat and fever; however the association of weight loss and hemoptysis were not significant. Concerning referral linkages, 277 (72. 1 %) patients were linked to ART clinic from In-patties it, Medical-outpatient, TB clinic, PMT-CT, General VCT, Other outpatient and PICT with intra-referral slips. 107 (27.9%) patients were referred from other health facilities to ART
clinic.
Conclusions and recommendations: chronic fatigue, cough, night sweat, and fever were the most frequently appeared symptom complexes of1 B among the screened patient's charts. There was no TB screening for VCT clients who were tested HIV positive at V T clinic. TPT & CPT were not provided for all eligible PLWHA. The referral linkages or HIV patients to ART clinic with intra-facility and inter-facility were through referral lips; however most of patient's referral slips were not documented. Routine TS screening for all VC'T clients who are tested HIV positive is recommended to be screened at VCT clinic. IPT & CPT wail be provided for all eligible PLWI-iA according to FMOH TB/HIV Implementation on guidelines. TS/HIV technical committee-IT ) at Hosp ital, Zonal and Regional level should be re-organize d and strengthen according to national TB/HIV guidelines. Periodic evaluation of TS and HIV programmers should be strengthen at all level. Regular supportive supervision, bi-annually and annually at program management level is recommended.
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Assessment of TB Screening and Ref! rral Linkage among HIV Patients Attending ART Clinic of Butajira Hospital, SNNPR, Ethiopia