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; Stephanie Bjerrum; Vincent Jessey Ganu; Augustine Kwashie; Joseph Oliver Commey; Yaw Adusi-Poku; Peter Puplampu; Åse Bengård Andersen; Ernest Kenu; Margaret Lartey; Isik Somuncu Johansen

doi:10.1016/j.ijid.2022.12.044

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^*, Stephanie Bjerrum, Vincent Jessey Ganu, Augustine Kwashie, Joseph Oliver Commey, Yaw Adusi-Poku, Peter Puplampu, Åse Bengård Andersen, Ernest Kenu, Margaret Lartey, Isik Somuncu Johansen

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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.

Originalsprog	Engelsk
Tidsskrift	International Journal of Infectious Diseases
Vol/bind	128
Sider (fra-til)	290-300
ISSN	1201-9712
DOI	https://doi.org/10.1016/j.ijid.2022.12.044
Status	Udgivet - mar. 2023

Bibliografisk note

Funding Information:
The authors are most grateful to the patients, hospital management, and staff of Lekma Hospital, Tema General Hospital and Korle-Bu Teaching Hospital who participated in this study. The authors thank research assistants at the study sites; the staff at the Chest Clinic and Fevers Unit Laboratories, Korle-Bu Teaching Hospital; staff at the National Public Health and Reference Laboratory, Korle-Bu; key personnel at the National TB Control Programme in Ghana; and Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark for their support during the study.

Funding Information:
J.Å. received grants from Julie von Müllens fond, Læge Agnethe Løvgreens legat, Torben og Alice Frimodts fond, A.P. Møller fonden, University of Southern Denmark Faculty of Health Sciences Ph.D. scholarship, University of Southern Denmark traveling fund, the Region of Southern Denmark, and Odense University Hospital Internationalization fund. I.S.J. received grants from the Strategic Research Council, Region of Southern Denmark. The funding sources had no influence on the study design, data collection, analysis, interpretation of the data, or the writing of the manuscript.

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10.1016/j.ijid.2022.12.044Licens: CC BY-NC-ND

Open Access VersionForlagets udgivne version, 2,02 MBLicens: CC BY-NC-ND

1 Ph.d.-afhandling

Point-of-care strategies to improve tuberculosis care among severely immunocompromised HIV-infected patients in Ghana
Åhsberg, J., 10. jul. 2023, Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet. 126 s.
Publikation: Afhandling › Ph.d.-afhandling

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Citationsformater

Åhsberg, J., Bjerrum, S., Ganu, V. J., Kwashie, A., Commey, J. O., Adusi-Poku, Y., Puplampu, P., Andersen, Å. B., Kenu, E., Lartey, M., & Johansen, I. S. (2023). 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. International Journal of Infectious Diseases, 128, 290-300. https://doi.org/10.1016/j.ijid.2022.12.044

@article{2b6874dc41e340cabf1b75f760833020,

title = "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",

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 = "Care cascade, COVID-19, Diagnosis, HIV, Tuberculosis, Xpert MTB/RIF",

author = "Johanna {\AA}hsberg and Stephanie Bjerrum and Ganu, {Vincent Jessey} and Augustine Kwashie and Commey, {Joseph Oliver} and Yaw Adusi-Poku and Peter Puplampu and Andersen, {{\AA}se Beng{\aa}rd} and Ernest Kenu and Margaret Lartey and Johansen, {Isik Somuncu}",

note = "Publisher Copyright: {\textcopyright} 2023 The Author(s)",

year = "2023",

month = mar,

doi = "10.1016/j.ijid.2022.12.044",

language = "English",

volume = "128",

pages = "290--300",

journal = "International Journal of Infectious Diseases",

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Åhsberg, J , Bjerrum, S, Ganu, VJ, Kwashie, A, Commey, JO, Adusi-Poku, Y, Puplampu, P, Andersen, ÅB, Kenu, E, Lartey, M & Johansen, IS 2023, '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', International Journal of Infectious Diseases, bind 128, s. 290-300. https://doi.org/10.1016/j.ijid.2022.12.044

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. / Åhsberg, Johanna ; Bjerrum, Stephanie; Ganu, Vincent Jessey et al.
I: International Journal of Infectious Diseases, Bind 128, 03.2023, s. 290-300.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - 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

AU - Åhsberg, Johanna

AU - Bjerrum, Stephanie

AU - Ganu, Vincent Jessey

AU - Kwashie, Augustine

AU - Commey, Joseph Oliver

AU - Adusi-Poku, Yaw

AU - Puplampu, Peter

AU - Andersen, Åse Bengård

AU - Kenu, Ernest

AU - Lartey, Margaret

AU - Johansen, Isik Somuncu

PY - 2023/3

Y1 - 2023/3

N2 - 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.

AB - 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.

KW - Care cascade

KW - COVID-19

KW - Diagnosis

KW - HIV

KW - Tuberculosis

KW - Xpert MTB/RIF

U2 - 10.1016/j.ijid.2022.12.044

DO - 10.1016/j.ijid.2022.12.044

M3 - Journal article

C2 - 36632893

AN - SCOPUS:85146871297

SN - 1201-9712

VL - 128

SP - 290

EP - 300

JO - International Journal of Infectious Diseases

JF - International Journal of Infectious Diseases

ER -

Åhsberg J , Bjerrum S, Ganu VJ, Kwashie A, Commey JO, Adusi-Poku Y et al. 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. International Journal of Infectious Diseases. 2023 mar.;128:290-300. doi: 10.1016/j.ijid.2022.12.044

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

Abstract

Bibliografisk note

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Point-of-care strategies to improve tuberculosis care among severely immunocompromised HIV-infected patients in Ghana

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