TY - JOUR
T1 - The in-hospital tuberculosis diagnostic cascade and early clinical outcomes among people living with HIV before and during the COVID-19 pandemic - a prospective multisite cohort study from Ghana
AU - Åhsberg, Johanna
AU - Bjerrum, Stephanie
AU - Ganu, Vincent Jessey
AU - Kwashie, Augustine
AU - Commey, Joseph Oliver
AU - Adusi-Poku, Yaw
AU - Puplampu, Peter
AU - Andersen, Åse Bengård
AU - Kenu, Ernest
AU - Lartey, Margaret
AU - Johansen, Isik Somuncu
N1 - Copyright © 2023. Published by Elsevier Ltd.
PY - 2023/3
Y1 - 2023/3
N2 - OBJECTIVES: The COVID-19 pandemic had a disruptive impact on tuberculosis (TB) and HIV services. We assessed the in-hospital TB diagnostic care among people with HIV (PWH) overall and before and during the pandemic.METHODS: In this prospective study, adult PWH admitted at three hospitals in Ghana were recruited if they had a positive World Health Organization four-symptom screen or one or more World Health Organization danger signs or advanced HIV. We collected data on patient characteristics, TB assessment, and clinical outcomes after 8 weeks and used descriptive statistics and survival analysis.RESULTS: We enrolled 248 PWH with a median clusters of differentiation 4 count of 80.5 cells/mm3 (interquartile range 24-193). Of those, 246 (99.2%) patients had a positive World Health Organization four-symptom screen. Overall, 112 (45.2%) patients obtained a sputum Xpert result, 66 (46.5%) in the prepandemic and 46 (43.4%) in the pandemic period; P-value = 0.629. The TB prevalence of 46/246 (18.7%) was similar in the prepandemic 28/140 (20.0%) and pandemic 18/106 (17.0%) population; P-value = 0.548. The 8-week all-cause mortality was 62/246 (25.2%), with no difference in cumulative survival when stratifying for the pandemic period; log-rank P-value = 0.412.CONCLUSION: The study highlighted a large gap in the access to TB investigation and high early mortality among hospitalized PWH, irrespective of the COVID-19 pandemic.
AB - OBJECTIVES: The COVID-19 pandemic had a disruptive impact on tuberculosis (TB) and HIV services. We assessed the in-hospital TB diagnostic care among people with HIV (PWH) overall and before and during the pandemic.METHODS: In this prospective study, adult PWH admitted at three hospitals in Ghana were recruited if they had a positive World Health Organization four-symptom screen or one or more World Health Organization danger signs or advanced HIV. We collected data on patient characteristics, TB assessment, and clinical outcomes after 8 weeks and used descriptive statistics and survival analysis.RESULTS: We enrolled 248 PWH with a median clusters of differentiation 4 count of 80.5 cells/mm3 (interquartile range 24-193). Of those, 246 (99.2%) patients had a positive World Health Organization four-symptom screen. Overall, 112 (45.2%) patients obtained a sputum Xpert result, 66 (46.5%) in the prepandemic and 46 (43.4%) in the pandemic period; P-value = 0.629. The TB prevalence of 46/246 (18.7%) was similar in the prepandemic 28/140 (20.0%) and pandemic 18/106 (17.0%) population; P-value = 0.548. The 8-week all-cause mortality was 62/246 (25.2%), with no difference in cumulative survival when stratifying for the pandemic period; log-rank P-value = 0.412.CONCLUSION: The study highlighted a large gap in the access to TB investigation and high early mortality among hospitalized PWH, irrespective of the COVID-19 pandemic.
KW - Care cascade
KW - COVID-19
KW - Diagnosis
KW - HIV
KW - Tuberculosis
KW - Xpert MTB/RIF
UR - http://www.scopus.com/inward/record.url?scp=85146871297&partnerID=8YFLogxK
U2 - 10.1016/j.ijid.2022.12.044
DO - 10.1016/j.ijid.2022.12.044
M3 - Journal article
C2 - 36632893
SN - 1201-9712
VL - 128
SP - 290
EP - 300
JO - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
ER -