Declining uptake of HIV testing among tuberculosis patients in Enugu state of Nigeria: the need for a reappraisal of strategy.

BACKGROUND The prevalence of HIV in Enugu State is the highest in Southeastern Nigeria. Since HIV is associated with TB, it is important to assess the performance of the Enugu State TB program as regards HIV screening of TB cases. This study assesses the proportions of TB cases that are screened for HIV as well as the prevalence of HIV among individuals with TB at the Enugu State TB program of Nigeria. MATERIALS AND METHODS The study was a retrospective review of data from the Enugu State TB program, Nigeria, from 2008 to 2009. Analysis was both descriptive and inferential at 95% confidence levels. RESULTS A total of 3,286 TB cases were registered within the 2-year period. Out of these, 1,867 (56.8%) were new sputum smear positive (ss+). In all, 67.9% and 78.9% of all-TB cases were screened for HIV in 2009 and 2008 respectively [OR=0.57 (0.48-0.67)]. Also, 83.0% and 87.9% of new ss+ cases were screened for HIV in 2009 and 2008 respectively [OR=0.68 (0.52-0.88)]. The mean HIV prevalence for all TB cases was 34.5%. CONCLUSION The performance of the State's TB program with respect to HIV screening of TB patients reduced significantly in 2009 when compared to 2008. Improved program monitoring and the opt-out approach of the provider initiated HIV testing and counseling are recommended.