Family-Based HIV VCT in Patients at Risk for Tuberculosis

The Family-Based HIV VCT in Patients at Risk for Tuberculosis (TB VCT) study aims to identify factors associated with uptake of HIV voluntary counselling and testing (VCT) testing among tuberculosis (TB) clinic attendees and their families. TB patients present one of the greatest opportunities for VCT to identify HIV infections and link individuals into HIV specific care. In the developing world, the HIV epidemic overlaps significantly with pre-existing epidemics of TB and the HIV prevalence among individuals newly diagnosed with TB is greater than 50%. Family and household members of TB patients, especially spouses and young children, also have a greatly elevated prevalence of HIV infection compared to that of the general population. However, VCT use among all these groups is low. The TB clinic at Mulago Hospital in Kampala, Uganda where this study is based has routinely offered HIV VCT to individuals newly diagnosed with TB since 2005. Our study extends the offer of VCT to any clinic attendee, regardless of TB diagnosis. Further, those who accept testing are invited to refer household members, and households are randomized to receive testing at home or in the clinic.

The specific aims of this study are:

Specific Aim 1: To determine the uptake of and barriers to HIV testing in a major TB evaluation center in Uganda.  We will accomplish this aim by measuring the proportion of TB evaluation patients who accept same-day results HIV VCT among a cross-sectional sample of 2,000 patients at the Uganda National TB and Leprosy Programme outpatient TB clinic at Old Mulago Hospital in Kampala, Uganda.

Specific Aim 2: To conduct a randomized trial comparing VCT uptake between Home-based HIV VCT and TB Clinic-based HIV VCT among family and household members of TB evaluation patients.   We will measure the number and proportion of family and household members who accept HIV VCT among 600 households randomized to either Home-based or TB Clinic-based HIV VCT and investigate barriers to family uptake of VCT and TB patient permission to refer family and household members for VCT.

Specific Aim 3: To investigate the effectiveness of TB Clinic-based and Home-based VCT in linking HIV infected persons to HIV medical care and social support.  Over time, we will measure the number and proportion of HIV infected persons among the 600 randomized households who keep referral appointments to medical care and social support, and receive ARV treatment or opportunistic infection prophylaxis.  Repeat assessments will be made at 1, 3, 6, 9, and 12 months from the date of HIV detection.

The results of this trial, if successful, will provide a model of TB/HIV VCT and linkage to care that could be rapidly implemented across sub-Saharan Africa given the substantial pre-existing TB control infrastructure in the region.  Barriers to VCT and linkage to care and support identified in this study will help focus future intervention research.