The yield of community-based tuberculosis and HIV among key populations in hotspot settings of Ethiopia: A cross-sectional implementation study

Abstract

Objective: To determine the yield of tuberculosis (TB) and the prevalence of Human Immuno-deficiency virus (HIV) among key populations in the selected hotspot towns of Ethiopia.

Methods: We undertook a cross-sectional implementation research during August 2017-January 2018. Trained TB focal persons and health extension workers (HEWs) identified female sex workers (FSWs), health care workers (HCWs), prison inmates, homeless, internally displaced people (IDPs), internal migratory workers (IMWs) and residents in missionary charities as key and vulnerable popuaiton. They carried out health education on the importance of TB screening and HIV testing prior to recruitment of the study participants. Symptomatic TB screening and HIV testing was done. The yield of TB was computed per 100,000 background key population.

Results: A total of 1878 vulnerable people were screened, out of which 726 (38.7%) presumptive TB cases and 87 (4.6%) TB cases were identified. The yield of TB was 1519 (95% CI: 1218.1-1869.9). The highest proportion (19.5%) and yield of TB case (6,286 (95% CI: 3980.8-9362.3)) was among HCWs. The prevalence of HIV infection was 6%, 67 out of 1,111 tested. IMWs and FSWs represented 49.3% (33) and 28.4% (13) of the HIV infections, respectively. There was a statistically significant association of active TB cases with previous history of TB (Adjusted Odds Ratio (AOR): 11 95% CI, 4.06-29.81), HIV infection (AOR: 7.7 95% CI, 2.24-26.40), and being a HCW (AOR: 2.42 95% CI, 1.09-5.34).

Conclusions: The prevalence of TB in key populations was nine times higher than 164/100,000 national estimated prevalence rate. The prevalence of HIV was five times higher than 1.15% of the national survey. The highest yield of TB was among the HCWs and the high HIV burden was detected among the FSWs and IMWs. These suggest a community and health facility based integrated and enhanced case finding approaches for TB and HIV in hotspot settings.

Fig 1. The flow chart shows sampling and selection of the key population.

Predefined key population are those whose number had already been documented and reported by the study towns’ health offices. The “defined during data collection” key population were those whose number were not known by the study towns’ health office and their background population was determined during the data collection period. The sampling frame was taken as the total key population in the study towns, and thus the background population to compute the yield or prevalence of TB. Bold arrow is to show the crude procedure one after the other; listing the sampling frame, random selection of one-third of the sampling frame, approaching for TB screening. Light arrow is to show the same procedure in each key population; FSW (female sex workers), IMW (internal migratory workers), IDP (internally displaced people), HCW (health care workers), missionary residents are the one supported by the charity organization. Most of the refusals were from HCW and FSW for they were busy, and from prison inmates. The malaria illness and other acute febrile illness made the other key population difficult to participate in the study.