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. 2023 Mar:128:290-300.
doi: 10.1016/j.ijid.2022.12.044. Epub 2023 Jan 9.

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

Johanna Åhsberg  1 , Stephanie Bjerrum  2 , Vincent Jessey Ganu  3 , Augustine Kwashie  4 , Joseph Oliver Commey  5 , Yaw Adusi-Poku  6 , Peter Puplampu  7 , Åse Bengård Andersen  8 , Ernest Kenu  9 , Margaret Lartey  7 , Isik Somuncu Johansen  10
Affiliations

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

Johanna Åhsberg et al. Int J Infect Dis. 2023 Mar.

Abstract

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.

Keywords: COVID-19; Care cascade; Diagnosis; HIV; Tuberculosis; Xpert MTB/RIF.

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Conflict of interest statement

Declaration of competing interest The authors have no competing interests to declare.

Figures

Figure 1
Figure 1
Eligibility screening. Abbreviations: LAM, lateral flow lipoarabinomannan; TB, tuberculosis; WHO, World Health Organization. a. Not able to give informed consent due to critical illness including cerebral impairment. b. Not having advanced HIV disease (WHO HIV stage III or IV or clusters of differentiation 4-cell count <200 cells/mm3) and not being seriously ill (defined by WHO danger signs) and not having a positive WHO TB symptom screening. c. HIV status not disclosed to the patient and other reasons that hindered an informed consent.
Figure 2
Figure 2
TB treatment initiation and 8 weeks all-cause mortality among admitted patients with HIV and high prevalence of WHO TB symptoms in Ghana, stratified by access to Xpert. Abbreviations: MTB, Mycobacterium tuberculosis; PWH, people with HIV; TB, Tuberculosis; WHO, World Health Organization; W4SS, WHO four-symptom screening; Xpert, sputum Xpert MTB/RIF. a. Xpert results from 14 days before the admission and until maximum 70 days post-enrollment were included in analysis.
Figure 3
Figure 3
The routine in-hospital TB diagnostic care cascade among 248 people with HIV at three hospitals in Ghana. Abbreviations: TB, Tuberculosis; WHO, World Health Organization; W4SS, WHO four-symptom screening; Xpert, sputum GeneXpert MTB/RIF. Percentages are rounded to zero decimal places. a.Two patients were lost to follow-up after discharge but were included in the denominator as ”Unlikely TB”.
Figure 4
Figure 4
Kaplan-Meier cumulative probability of 8 weeks survival among people with HIV stratified by admission to hospital in the prepandemic and the COVID-19 pandemic period.
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