Background
The high prevalence of alcohol use disorder (AUD) in sub-Saharan Africa is strongly associated with HIV acquisition and a greater risk of tuberculosis (TB) disease. An integrated HIV and TB case finding strategy targeting persons with AUD at social drinking venues (SDVs) could be an efficient and scalable approach for bolstering the detection of both diseases in high-prevalence settings, but the potential effectiveness is unproven.
Methods
A prospective, cross-sectional pilot study was conducted to evaluate a systematic HIV and TB case finding strategy among individuals at SDVs in two high HIV/TB burden communities in Lusaka, Zambia. Persons were eligible if they were age ≥18 years, an SDV patron or employee, not currently receiving TB treatment, willing to get tested for TB, and were without signs of intoxication. All participants underwent rapid HIV testing if they had a negative or unknown status and were evaluated for TB regardless of symptoms using sputum Xpert Ultra and culture. The diagnostic yield and associated number needed to test (NNT) were determined for new HIV and TB diagnoses.
Results
Of 582 screened, 448 met eligibility criteria, and 443 had complete data and were included (median age 37 [IQR, 30-44], 71.8% male, 88.3% patrons, 96.8% had AUD (median AUDIT-C 8 [IQR, 8-12]). Overall, 95.9% (n=425) had been previously tested for HIV – 31.8% (n=135) reported being a person living with HIV (PWH), of which 94.1% (n=127) were currently receiving ART. Of 308 participants with an unknown or previously negative HIV status, 10 (3.2%) tested newly positive for HIV (NNT=31); thus, the overall HIV prevalence was 32.7% (n=145). 39.1% (n=173) of participants had previously been tested for TB, 16.3% (n=72) had a prior history of TB disease, and 4.7% (n=21) had newly microbiologically confirmed pulmonary TB (NNT=21). There was a trend toward a higher yield of new HIV diagnoses among patrons compared to employees (3.7% vs. 0%;p=0.29), while there was a higher yield of new TB diagnoses among employees compared to patrons (11.5% vs. 3.8%;p=0.026). Overall, 99.3% (n=443) were willing to participate in a similar program in the future if periodically offered by the Ministry of Health.
Conclusions
A novel, integrated case finding strategy at social drinking venues shows substantial promise for increasing HIV and TB detection by delivering services directly to where people with alcohol use disorder gather. Larger studies are needed to confirm its effectiveness and implementability.