Author:
Shapiro Anne N.,Scott Lesley,Moultrie Harry,Jacobson Karen R.,Bor Jacob,Fofana Abdou M.,Dor Graeme,Ndjeka Norbert O.,da Silva Pedro,Mlisana Koleka,Jenkins Helen E.,Stevens Wendy S.
Abstract
AbstractThe National Health Laboratory Service (NHLS) collects all public health laboratory test results in South Africa, providing a cohort from which to identify groups, by age, sex, HIV, and viral suppression status, that would benefit from increased tuberculosis (TB) testing. Using NHLS data (2012–2016), we assessed levels and trends over time in TB diagnostic tests performed (count and per capita) and TB test positivity. Estimates were stratified by HIV status, viral suppression, age, sex, and province. We used logistic regression to estimate the odds of testing positive for TB by viral suppression status. Nineteen million TB diagnostic tests were conducted during period 2012–2016. Testing per capita was lower among PLHIV with viral suppression than those with unsuppressed HIV (0.08 vs 0.32) but lowest among people without HIV (0.03). Test positivity was highest among young adults (aged 15–35 years), males of all age groups, and people with unsuppressed HIV. Test positivity was higher for males without laboratory evidence of HIV than those with HIV viral suppression, despite similar individual odds of TB. Our results are an important national baseline characterizing who received TB testing in South Africa. People without evidence of HIV, young adults, and males would benefit from increased TB screening given their lower testing rates and higher test positivity. These high-test positivity groups can be used to guide future expansions of TB screening.
Funder
National Institute of Allergy and Infectious Diseases
Publisher
Springer Science and Business Media LLC
Reference35 articles.
1. Global tuberculosis report 2021. (World Health Organization, Geneva, 2021).
2. Global tuberculosis report 2020. (World Health Organization, Geneva, 2020).
3. UNAIDS. 90-90-90: Treatment for all https://www.unaids.org/en/resources/909090 (2020).
4. National Tuberculosis Management Guidelines. (Department of Health, Republic of South Africa 2014).
5. Bor, J. et al. Building a National HIV Cohort from Routine Laboratory Data: Probabilistic Record-Linkage with Graphs. Pre-Print (2018). https://doi.org/10.1101/450304