Counseling and testing TB patients for HIV: evaluation of three implementation models in Kinshasa, Congo.

SETTING

Kinshasa, Democratic Republic of Congo.

OBJECTIVES

To evaluate the implementation of three models of provider-initiated HIV counseling and testing (CT) for tuberculosis (TB) patients.

METHODS

HIV CT was offered to all TB patients aged > or =18 months registered for treatment at three project clinics between August 2004 and June 2005. HIV CT was performed at the TB clinic, the health center or the freestanding voluntary counseling and testing (VCT) center. HIV-infected patients received cotrimoxazole prophylaxis.

RESULTS

Uptake of HIV CT was high (95-98%) when performed at the TB clinic or primary health care center, but significantly lower (68.5%) among patients referred to a free-standing VCT center. The overall HIV prevalence among the 1088 patients tested for HIV was 18.8%. HIV was associated with female sex (aOR 1.91), recurrent TB (aOR 2.74), extra-pulmonary TB (aOR 1.97) and age.

CONCLUSIONS

Implementation of provider-initiated routine HIV CT by the TB nurse or health care worker at the primary health care center results in a higher uptake compared to referral of patients with TB to freestanding VCT clinics. Provider-initiated HIV CT is only a first step and needs to be linked to access to HIV care, support and treatment.