DURBAN, South Africa – The average number of monthly tuberculosis diagnoses among the HIV patients increased twenty-fold, and pediatric TB was diagnosed for the first time at a busy Malawi hospital after a pilot intervention provided community health workers already experienced in HIV screening and care linkage with a one-day training to learn to screen for tuberculosis, a July 20 presentation here showed.
The training, focused primarily on asking patients four questions — if they had a current cough, had a recent fever, experienced recent weight loss or night sweats— prepared health workers to conduct patient screening at the Salima District Hospital antiretroviral treatment clinic where 4800 patients received medications and care.
In Malawi, where almost 10 percent of the population lives with HIV, and 980,000 people are on antiretroviral treatment, tuberculosis is the most common cause of death in people with HIV. Most HIV care is provided by nurses and clinical officers and tuberculosis is commonly diagnosed there by smear microscopy, which has been shown to miss about half of all cases of active tuberculosis.
To improve the diagnosis of TB in HIV patients in care, researchers enlisted the help of a community health worker program primarily focused on prevention of HIV transmission from mother to child. Trainees were experienced case managers who conducted HIV case-finding among the women and children they served. Patients who responded affirmatively to any of the four questions health workers were trained to ask received immediate clinical assessments including smear microscopy and a Gene Xpert diagnostic test. The first month following the training saw an increase of 6.7 diagnoses, compared to the previous monthly average. And while no TB diagnoses had been made among children in the 16 months prior to the intervention, nine pediatric cases were identified within the first six months of the intervention.
Each patient diagnosed with active tuberculosis was assigned a community health worker case manager who offered treatment support as well as outreach to other potential TB and HIV contacts.
Results of the pilot project were presented by Dr. Katie Simon from the Baylor School of Medicine Children’s Foundation Malawi, on behalf of Dr. Robert Flick from the University of North Carolina Project Malawi. Researchers are evaluating patient treatment outcomes assessing the time between diagnosis to treatment, she said. In the meantime, Dr. Simon said, community health workers are now screening patients at 20 facilities with hopes that the effort will be effective and will last over time.