Volume 87, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Among tuberculosis patients, timely diagnosis of human immunodeficiency virus (HIV) co-infection and early antiretroviral treatment are crucial, but are hampered by a myriad of individual and structural barriers. Community-based models to provide counseling and rapid HIV testing are few but offer promise. During November 2009–April 2010, community health workers offered and performed HIV counseling and testing by using the OraQuick Rapid HIV-1/2 Antibody Test to new tuberculosis cases in 22 Ministry of Health establishments and their household contacts (n = 130) in Lima, Peru. Refusal of HIV testing or study participation was low (4.7%). Intervention strengths included community-based approach with participant preference for testing site, use of a rapid, non-invasive test, and accompaniment to facilitate HIV care and family disclosure. We will expand the intervention under programmatic auspices for rapid community-based testing for new tuberculosis cases in high incidence establishments. Other potential target populations include contacts of HIV-positive persons and pregnant women.


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  1. TB/HIV Working Group of the Global Partnership to Stop TB WHO, , 2004. Guidelines for HIV Surveillance among Tuberculosis Patients. Second edition. Geneva: World Health Organization.
  2. Obermeyer Z, Abbott-Klafter J, Murray CJ, , 2008. Has the DOT strategy improved case finding or treatment success? An empirical assessment. PLoS ONE 3: e1721.[Crossref]
  3. Raviglione MC, Pio A, , 2002. Evolution of WHO policies for tuberculosis control, 1948–2001. Lancet 359: 775780.[Crossref]
  4. Garcia-Garcia M de L, Ponce-De-Leon A, Garcia-Sancho MC, Ferreyra-Reyes L, Palacios-Martinez M, Fuentes J, Kato-Maeda M, Bobadilla M, Small P, Sifuentes-Osornio J, , 2002. Tuberculosis-related deaths within a well-functioning DOTS control program. Emerg Infect Dis 8: 13271333.[Crossref]
  5. Whalen CC, Nsubuga P, Okwera A, Johnson JL, Hom DL, Michael NL, Mugerwa RD, Ellner JJ, , 2000. Impact of pulmonary tuberculosis on survival of HIV-infected adults: a prospective epidemiologic study in Uganda. AIDS 14: 12191228.[Crossref]
  6. Badri M, Ehrlich R, Wood R, Pulerwitz T, Maartens G, , 2001. Association between tuberculosis and HIV disease progression in a high tuberculosis prevalence area. Int J Tuberc Lung Dis 5: 225232.
  7. Chaisson RE, Schecter GF, Theuer CP, Rutherford GW, Echenberg DF, Hopewell PC, , 1987. Tuberculosis in patients with the acquired immunodeficiency syndrome. Clinical features, response to therapy, and survival. Am Rev Respir Dis 136: 570574.[Crossref]
  8. Nunn P, Brindle R, Carpenter L, Odhiambo J, Wasunna K, Newnham R, Githui W, Gathua S, Omwega M, McAdam K, , 1992. Cohort study of human immunodeficiency virus infection in patients with tuberculosis in Nairobi, Kenya. Analysis of early (6-month) mortality. Am Rev Respir Dis 146: 849854.[Crossref]
  9. Kawai V, Soto G, Gilman RH, Bautista CT, Caviedes L, Huaroto L, Ticona E, Ortiz J, Tovar M, Chavez V, Rodriguez R, Escombe AR, Evans CA, , 2006. Tuberculosis mortality, drug resistance, and infectiousness in patients with and without HIV infection in Peru. Am J Trop Med Hyg 75: 10271033.
  10. Li J, Munsiff SS, Driver CR, Sackoff J, , 2005. Relapse and acquired rifampin resistance in HIV-infected patients with tuberculosis treated with rifampin- or rifabutin-based regimens in New York City, 1997–2000. Clin Infect Dis 41: 8391.[Crossref]
  11. Burman W, Benator D, Vernon A, Khan A, Jones B, Silva C, Lahart C, Weis S, King B, Mangura B, Weiner M, El-Sadr W, , 2006. Acquired rifamycin resistance with twice-weekly treatment of HIV-related tuberculosis. Am J Respir Crit Care Med 173: 350356.[Crossref]
  12. Center for Disease Control, 2002. Acquired rifamycin resistance in persons with advanced HIV disease being treated for active tuberculosis with intermittent rifamycin-based regimens. MMWR Morb Mortal Wkly Rep 51: 214215.
  13. Havlir DV, Kendall MA, Ive P, Kumwenda J, Swindells S, Qasba SS, Luetkemeyer AF, Hogg E, Rooney JF, Wu X, Hosseinipour MC, Lalloo U, Veloso VG, Some FF, Kumarasamy N, Padayatchi N, Santos B, Reid S, Hakim J, Mohapi L, Mugyenyi P, Sanchez J, Lama J, Pape J, Sanchez A, Asmelash A, Moko E, Sawe F, Andersen J, Sanne I, , 2011. Timing of antiretroviral therapy for HIV-1 infection and tuberculosis. N Engl J Med 365: 14821491.[Crossref]
  14. Blanc FX, Sok T, Laureillard D, Borand L, Rekacewicz C, Nerrienet E, Madec Y, Marcy O, Chan S, Prak N, Kim C, Lak KK, Hak C, Dim B, Sin CI, Sun S, Guillard B, Sar B, Vong S, Fernandez M, Fox L, Delfraissy JF, Goldfeld AE, , 2011. Earlier versus later start of antiretroviral therapy in HIV-infected adults with tuberculosis. N Engl J Med 365: 14711481.[Crossref]
  15. Abdool Karim SS, Naidoo K, Grobler A, Padayatchi N, Baxter C, , 2010. Timing of initiation of antiretroviral drugs during tuberculosis therapy. N Engl J Med 362: 697706.[Crossref]
  16. Heunis JC, Wouters E, Norton W, Engelbrecht M, Kigozi N, Sharma A, Ragin C, , 2011. Patient- and delivery-level factors related to acceptance of HIV counseling and testing services among tuberculosis patients in South Africa: a qualitative study with community health workers and program managers. Implement Sci 6: 27.[Crossref]
  17. Okot-Chono R, Mugisha F, Adatu F, Madraa E, Dlodlo R, Fujiwara P, , 2009. Health system barriers affecting the implementation of collaborative TB-HIV services in Uganda. Int J Tuberc Lung Dis 13: 955961.
  18. Holm-Hansen C, Nyombi B, Nyindo M, , 2007. Saliva-based HIV testing among secondary school students in Tanzania using the OraQuick rapid HIV1/2 antibody assay. Ann N Y Acad Sci 1098: 461466.[Crossref]
  19. Pope DS, Deluca AN, Kali P, Hausler H, Sheard C, Hoosain E, Chaudhary MA, Celentano DD, Chaisson RE, , 2008. A cluster-randomized trial of provider-initiated (opt-out) HIV counseling and testing of tuberculosis patients in South Africa. J Acquir Immune Defic Syndr 48: 190195.[Crossref]
  20. Centers for Disease Control and Prevention, 2008. Provider-initiated HIV testing and counseling of TB patients–Livingstone District, Zambia, September 2004–December 2006. MMWR Morb Mortal Wkly Rep 57: 285289.
  21. Kassler WJ, Alwano-Edyegu MG, Marum E, Biryahwaho B, Kataaha P, Dillon B, , 1998. Rapid HIV testing with same-day results: a field trial in Uganda. Int J STD AIDS 9: 134138.[Crossref]
  22. Myers JJ, Modica C, Dufour MS, Bernstein C, McNamara K, , 2009. Routine rapid HIV screening in six community health centers serving populations at risk. J Gen Intern Med 24: 12691274.[Crossref]
  23. Diserens EA, Bodenmann P, N'Garambe C, Ansermet-Pagot A, Vannotti M, Masserey E, Cavassini M, , 2010. Clients of sex workers in Switzerland: it makes sense to counsel and propose rapid test for HIV on the street, a preliminary report. BMC Infect Dis 10: 74.[Crossref]
  24. Roberts KJ, Grusky O, Swanson AN, , 2007. Outcomes of blood and oral fluid rapid HIV testing: a literature review, 2000–2006. AIDS Patient Care STDS 21: 621637.[Crossref]
  25. Helleringer S, Kohler HP, Frimpong JA, Mkandawire J, , 2009. Increasing uptake of HIV testing and counseling among the poorest in sub-Saharan countries through home-based service provision. J Acquir Immune Defic Syndr 51: 185193.[Crossref]
  26. de la Fuente L, Delgado J, Hoyos J, Belza MJ, Alvarez J, Gutierrez J, Neira-Leon M, Suarez M, , 2009. Increasing early diagnosis of HIV through rapid testing in a street outreach program in Spain. AIDS Patient Care STDS 23: e9.[Crossref]
  27. Ellen JM, Bonu S, Arruda JS, Ward MA, Vogel R, , 2003. Comparison of clients of a mobile health van and a traditional STD clinic. J Acquir Immune Defic Syndr 32: 388393.[Crossref]
  28. Guenter D, Greer J, Barbara A, Robinson G, Roberts J, Browne G, , 2008. Rapid point-of-care HIV testing in community-based anonymous testing program: a valuable alternative to conventional testing. AIDS Pateint Care STDS 22: 195204.[Crossref]
  29. Seña AC, Hammer JP, Wilson K, Zeveloff A, Gamble J, , 2010. Feasibility and acceptability of door-to-door rapid HIV testing among Latino immigrants and their HIV risk factors in North Carolina. AIDS Patient Care STDS 24: 165173.[Crossref]
  30. Baiden F, Akanlu G, Hodgson A, Akweongo P, Debpuur C, Binka F, , 2007. Using lay counsellors to promote community-based voluntary counselling and HIV testing in rural northern Ghana: a baseline survey on community acceptance and stigma. J Biosoc Sci 39: 721733.[Crossref]
  31. Lahuerta M, Sabido M, Giardina F, Hernandez G, Palacios JF, Ortiz R, Fernandez VH, Casabona J, , 2011. Comparison of users of an HIV/syphilis screening community-based mobile van and traditional voluntary counselling and testing sites in Guatemala. Sex Transm Infect 87: 136140.[Crossref]
  32. Molesworth AM, Ndhlovu R, Banda E, Saul J, Ngwira B, Glynn JR, Crampin AC, French N, , 2010. High accuracy of home-based community rapid HIV testing in rural Malawi. J Acquir Immune Defic Syndr 55: 625630.[Crossref]
  33. Angotti N, Bula A, Gaydosh L, Kimchi EZ, Thornton RL, Yeatman SE, , 2009. Increasing the acceptability of HIV counseling and testing with three C's: convenience, confidentiality and credibility. Soc Sci Med 68: 22632270.[Crossref]
  34. Ganguli I, Bassett IV, Dong KL, Walensky RP, , 2009. Home testing for HIV infection in resource-limited settings. Curr HIV/AIDS Rep 6: 217223.[Crossref]
  35. Farmer P, Robin S, Ramilus SL, Kim JY, , 1991. Tuberculosis, poverty, and “compliance”: lessons from rural Haiti. Semin Respir Infect 6: 254260.
  36. Mitnick C, Bayona J, Palacios E, Shin S, Furin J, Alcantara F, Sanchez E, Sarria M, Becerra M, Fawzi MC, Kapiga S, Neuberg D, Maguire JH, Kim JY, Farmer P, , 2003. Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. N Engl J Med 348: 119128.[Crossref]
  37. Shin S, Furin J, Bayona J, Mate K, Kim JY, Farmer P, , 2004. Community-based treatment of multidrug-resistant tuberculosis in Lima, Peru: 7 years of experience. Soc Sci Med 59: 15291539.[Crossref]
  38. Mukherjee JS, Ivers L, Leandre F, Farmer P, Behforouz H, , 2006. Antiretroviral therapy in resource-poor settings: decreasing barriers to access and promoting adherence. J Acquir Immune Defic Syndr 43 (Suppl 1): S123S126.[Crossref]
  39. UNAIDS, 2011. Lucha Contra VIH/SIDA. Lima, Peru: UNAIDS.
  40. Alliance IHA, , 2011. Peru: 24/24 Country. Special on Via Libre. Lima, Peru: Alliance IHA, ed. Special on Via Libre.
  41. Holguín A, Gutiérrez M, Portocarrero N, Rivas P, Baquero M, , 2009. Performance of OraQuick Advance® Rapid HIV-1/2 Antibody Test for detection of antibodies in oral fluid and serum/plasma in HIV-1+ subjects carrying different HIV-1 subtypes and recombinant variants. J Clin Virol 45: 150152.[Crossref]
  42. Ministry of Health, 2008. Documento Técnico: Consejería en ITS/VIH y SIDA. Lima, Peru: Gobierno de Peru.
  43. Navaline HA, Snider EC, Petro CJ, Tobin D, Metzger D, Alterman AI, Woody GE, , 1994. Preparations for AIDS vaccine trials. An automated version of the Risk Assessment Battery (RAB): enhancing the assessment of risk behaviors. AIDS Res Hum Retroviruses 10 (Suppl 2): S281S283.
  44. Samet JH, Krupitsky EM, Cheng DM, Raj A, Egorova VY, Levenson S, Meli S, Bridden C, Verbitskaya EV, Kamb ML, Zvartau EE, , 2008. Mitigating risky sexual behaviors among Russian narcology hospital patients: the PREVENT (Partnership to Reduce the Epidemic via Engagement in Narcology Treatment) randomized controlled trial. Addiction 103: 14741483.[Crossref]
  45. UNAIDS Peru, 2009. HIV and AIDS Estimates. Lima, Peru: UNAIDS.
  46. Lugada E, Levin J, Abang B, Mermin J, Mugalanzi E, Namara G, Gupta S, Grosskurth H, Jaffar S, Coutinho A, Bunnell R, , 2010. Comparison of home and clinic-based HIV testing among household members of persons taking antiretroviral therapy in Uganda: results from a randomized trial. J Acquir Immune Defic Syndr 55: 245252.[Crossref]

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  • Received : 16 Jan 2012
  • Accepted : 12 Apr 2012

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