Family-Based HIV VCT in Patients at Risk for TB

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DESCRIPTION (provided by applicant): The global call for the rapid introduction of HIV antiretroviral therapy to sub-Saharan Africa urgently requires improved identification of HIV infected persons and successful linkage to HIV medical care and social support. Voluntary Counseling and Testing (VCT) for HIV has been shown to be effective in helping individuals learn their HIV status and get into care. Tuberculosis (TB) patients present one of the greatest opportunities for VCT to identify HIV infections and link individuals into HIV specific care. In the developing world, the HIV epidemic overlaps significantly with pre-existing epidemics of TB and the HIV prevalence among individuals newly diagnosed with TB is greater than 50%. Family and household members of TB patients, especially spouses and young children, also have a greatly elevated prevalence of HIV infection compared to that of the general population. However, VCT use among all these groups is low (<10%). We propose to test the efficacy of an intervention utilizing HIV rapid testing and integration of HIV VCT into TB evaluation and home-based VCT for family members, to overcome identified logistical and psychological barriers to HIV VCT among new TB patients HIV and their family members. The specific aims of the study are: 1) To determine the uptake of and barriers to VCT among a cross-sectional sample of 2,000 TB evaluation patients offered same-day results HIV counseling and testing at the Uganda National TB and , Leprosy Programme outpatient TB clinic at Old Mulago Hospital in Kampala, Uganda. 2) To conduct a randomized trial of HIV VCT among 600 households comparing VCT uptake between Home-based VCT and TB Clinic-based VCT for family and household members of TB evaluation patients. 3) To investigate the effectiveness of Home-based and TB Clinic-based VCT in linking HIV infected persons among the 600 randomized households to HIV medical care and social support.