Is Screening For HIV In Female Tuberculous Patients Cost Effective?

Muhammad Saqib Musharaf, Umer Usman

Abstract


Background: Tuberculosis is one of most ancient documented disease and yet with so much progress in medicine, it still in top ten deadly diseases. HIV has changed the scenario when it combines with TB. TB which was initially thought to be disease of developing countries is now a major public health problem for developed nation as well. In two thousand seventeen 940,000 people died of AIDS-related illnesses. Pakistan ranks 5th among high burden tuberculous patients countries. Fortunately, HIV is less prevalent here. As most of health committees recommend screening for HIV at the time of diagnosis of TB. No study to our date has been done specifically in female population with this context to evaluate the prevalence and cost effectiveness of HIV screening. 

Objective: Objective of the present study was to see the prevalence of HIV among female tuberculous patients presenting to pulmonology ward Gulab Devi Chest Hospital Lahore. 

Methodology: This was cross sectional study that was carried out from July 2018 to August 2018. Only female patients with age more than fourteen years were enrolled. Physician based diagnosis or bacteriological positive tuberculous patients were eligible for study. Both pulmonary and extrapulmonary tuberculosis patient were included. Once consent given for HIV test, patients were tested for HIV by screening. 

Results: Four hundred and ninety two patients were presented and counseled for screening in the study period. Total of 426 patients were enrolled in the study with mean age of 39.2+17.7 years. Pulmonary tuberculosis (PTB) was commonest form of TB i.e. 91.3% (n= 368). Pleural effusion was the most common extra-pulmonary (EP) form of tuberculosis 10.3% (n= 44). Majority of patients were new cases 95.3% (n= 406). HIV screening was negative in most of patients 99.5% (n= 424).

Conclusion: Although tuberculosis is common here, HIV is less prevalent here. Screening for HIV, during routine workup for TB is beneficially in high burden countries for HIV. This study shows that it is not cost effective to screen our female population for TB, as HIV is less prevalent here when compared to male population. Moreover, with tightening economic situation and already heavy burden on health system, the screening for HIV will add to the cost of diagnosis of female tuberculosis patients, with little or no clinical benefit.


Keywords


Human Immune Deficiency Virus (HIV); PTB; Extra-pulmonary tuberculosis (EPTB)

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