Leveraging portable digital x-ray to strengthen tb case finding among people living with HIV in Gandaki province

Abstract

Abstract: Introduction: Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) remain pressing global public health challenges, particularly in low- and middle-income countries like Nepal. TB is the leading cause of death among people living with HIV (PLHIV), accounting for a significant proportion of AIDS-related deaths. The co-infection of TB and HIV presents complex challenges, including delayed diagnosis, overlapping drug regimens and increased risk of mortality. Despite progress, Nepal continues to face a high burden of TB, including multidrug-resistant TB (MDR-TB), with limited early detection tools for high-risk groups such as PLHIV. This study aimed to strengthen TB case finding among PLHIV in Gandaki Province by leveraging portable digital X-ray technology integrated with CAD4TB (Computer-Aided Detection for Tuberculosis). Methods: A cross-sectional survey was conducted among HIV-positive patients attending (Antiretroviral Therapy) ART centers across diverse ecological regions (mountain, hill, and Terai districts). All participants were undergone digital chest X-ray screening and presumptive TB cases were confirmed through Gene-Xpert testing at the Provincial Tuberculosis Control Center. A total of 260 participants were enrolled. Ethical approval was obtained from the Institutional Review Committee (IRC), Pokhara University (105/2082/83) and relevant authorities. Findings: The study done among 260 people living with HIV registered in different ART center, demonstrated that study participants comprise of 58.5% (n=152) and 41.5% (n=108) female and males respectively. The majority were aged below 45 years (46.2%), followed Hindu religion (75.4%), from urban areas (75.0%), and living in nuclear families (84.6%). The Gene-Xpert test revealed that 81.1% (n=30) tested negative for MTB, while 16.2% (n=6) tested positive. Among positive cases, MTB was detected with high bacterial load (8.1%), medium bacterial load (5.4%), and very low bacterial load (2.7%). Majority of participants (60.8%) had normal body mass index. Also, digital chest X-ray screening was found to be normal among 85.8% of participants, while 14.2% of participants were suggestive of active or old tuberculosis (TB). The Gene-Xpert positivity rate was found to be 18.92%. This study found the TB prevalence as 2.69% (7/260) and 42.3% were having comorbidities. The bivariate analysis sex, ethnicity, alcoholic history, comorbidities, viral load, close contact with TB patient and symptoms of TB as predictors of TB infection among PLHIV. However, after adjustment in multivariate analysis ethnicity was identified as a main predictor for getting TB. Conclusion: This study determined the prevalence of TB infection and association with different relevant factors among people living with HIV in Nepal. The findings emphasize the importance of strengthening active TB screening and comprehensive assessment, of associated risk factors among PLHIV using the portable digital X-ray in order to design the targeted interventions for high-risk subgroups and ensure timely treatment. It is crucial for the achievement of national target of ending TB. These evidences suggest the early and efficient way of strengthening the active TB case findings by use of available resources such as digital chest X-ray. This insight should be incorporated into future HIV/TB control programs to reduce the financial burden of screening TB among PLHIV in Nepal by using portable digital Xray