Int J Infect Dis. 2023 Jan 9:S1201-9712(22)00683-X. doi: 10.1016/j.ijid.2022.12.044. Online ahead of print.
ABSTRACT
BACKGROUND: 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, 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 (W4SS), or one or more WHO 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 CD4 count of 80.5 cells/mm3 (IQR 24-193). Of those, 246 (99.2%) patients had a positive W4SS. Overall, 112 (45.2%) patients obtained a sputum Xpert result, 66 (46.5%) in the pre-pandemic and 46 (43.4%) in the pandemic period, p=0.629. The TB prevalence of 46/246 (18.7%) was similar in the pre-pandemic 28/140 (20.0%) and pandemic 18/106 (17.0%) population, p=0.548. The 8 weeks all-cause mortality was 62/246 (25.2%) with no difference in cumulative survival when stratifying for pandemic period, log-rank p=0.412.
CONCLUSIONS: The study highlighted a large gap in access to TB investigation and high early mortality among hospitalized PWH, irrespective of the COVID-19 pandemic.
PMID:36632893 | DOI:10.1016/j.ijid.2022.12.044
