April 2014—A patient questionnaire, designed to screen for TB symptoms, is improving TB diagnostics among people living with HIV and giving patients a chance for a faster recovery.
Andriy* has lived with HIV since 2010. When first diagnosed, he didn’t feel bad. Nor did he pay much attention to the mild cough and fatigue that he had been experiencing. These minor symptoms didn’t seem important until his physician became interested in them.
TB infection is currently the most common cause of death among people living with HIV (PLWH), annually responsible for more than 60 percent of deaths among PLWH in Ukraine. One main cause of this high mortality rate is the fact that TB diagnosis is overwhelmingly hindered by inefficiency and delay.
“TB was my biggest health-related fear, ever since I became familiar with my HIV status,” said Andriy. “I was always on the alert for really bad symptoms, knowing that TB kills HIV-positive people. But I never thought that something as common as a cough could indicate such a threatening disease.”
The World Health Organization recommends patient surveys designed to help identify TB symptoms as one of the most efficient methods for conducting regular TB screening among PLWH. In 2013, with the support of the USAID Strengthening Tuberculosis Control in Ukraine project, such patient questionnaires were introduced as the primary method of early TB screening and diagnosis in AIDS centers in 10 USAID-funded regions.
“The surveys are very useful both for the patient and the doctor. No TB symptoms are overlooked and filling them out takes much less time than would a discussion on the matter," said Dr. Iryna Bondar of the Kharkiv oblast AIDS Center.
“If not for the screening form, I would have never paid any attention to my cough,” explained Andriy.
Since its introduction, nearly 21,000 PLWH, or about 90 percent of PLWH who visited an AIDS center during that time, have completed the survey with their doctors. These screening interviews resulted in about one in three patients being referred to sputum smear microscopy and about 8 percent overall testing positive for TB. This represents an increase in the rate of TB detection of nearly 40 percent since doctors began using this new screening tool.
The results demonstrate that more patients elect to get tested for TB when they understand that they could be at risk. In practical terms, this means that more TB cases are diagnosed in a reasonable amount of time, which means that these patients have a much better chance of being successfully cured.
“It’s hard to feel happy when you receive a diagnosis of TB,” observed Andriy. “But I am lucky, because I know that the disease was detected at an early stage. I will complete my treatment course and the TB won’t kill me.”
*Full name withheld to protect identity.
Last updated: June 09, 2016