Integration of tuberculosis screening at an HIV voluntary counselling and testing centre in Haiti

Objective: To describe the integration of tuberculosis screening into the a ctivities of an HIV voluntary counselling and testing (VCT) centre in a cou ntry with endemic tuberculosis. Setting: An HIV VCT centre in Port au Prince, Haiti. Design: All patients presenting for HIV VCT who reported cough received sam e-day evaluation for active tuberculosis. Of the 1327 adults presenting to the centre for the first time between January and April 1997, 263 (20%) rep orted cough and of these 241 (92%) were evaluated. Results: Of the 241 patients evaluated for cough, 76 (32%) were diagnosed w ith pulmonary tuberculosis. Of the 76 patients diagnosed with pulmonary tub erculosis, 28 (37%) had a positive smear for acid-fast bacilli (AFB), 14 (1 8%) had a negative AFB smear but a positive sputum culture for Mycobacteriu m tuberculosis, and 34 (45%) had culture-negative tuberculosis. Also, 31 ou t of 241 (13%) VCT clients evaluated for cough were diagnosed with bacteria l pneumonia. Conclusion: This report confirms that in areas with a high HIV and tubercul osis prevalence, a high proportion of VCT clients have active pulmonary tub erculosis. The integration of tuberculosis screening offers several benefit s, including the diagnosis and treatment of large numbers of individuals wi th tuberculosis, a decreased risk of nosocomial tuberculosis transmission, and the opportunity to provide tuberculosis prophylaxis to HIV-positive pat ients in whom tuberculosis has been excluded. Future studies are needed to determine the cost-effectiveness of integrated tuberculosis and HIV VCT ser vices, and whether integration should be recommended in all countries with high HIV and tuberculosis rates. (C) 2001 Lippincott Williams & Wilkins.