Determinants of sputum ordering for tuberculosis diagnosis in people living with HIV in the Greater Accra Region, Ghana

Abstract

Background: This study assessed factors associated with sputum ordering for tuberculosis (TB) diagnosis in people living with HIV (PLHIV) who were screened positive for TB in three hospitals providing HIV care and treatment services in the Greater Accra region of Ghana.
Objective: This study assessed the factors associated with sputum ordering in PLHIV with a positive TB symptom screen test.
Methods: A mixed-method cross-sectional study was undertaken at three hospitals providing HIV care and treatment services in the Greater Accra region of Ghana. The study involved a review of 400 patients' charts and in-depth interviews with health workers involved in the care and treatment of PLHIV. Bivariate analysis using a Chi-square test and Logistic regression for multivariate analysis were used to establish factors associated with sputum ordering. Factors having a p ≤ 0.05 were considered significantly associated with sputum ordering. Inductive thematic analysis was used to explain the associated factors.
Results: Of the 400 charts reviewed, 67.7% were female patients with a median age of 39 (IQR 31 ̶ 49). TB screening was recorded in 78% (n = 312/400, 95% CI: 73.6 ̶ 82.0) of the patients, of whom ninety-two (92) patients had a positive TB screen test. Only 57.6% (n = 53) who had a positive screen test had sputum ordered for further TB testing. In the multivariate analysis, the patient's general appearance was described as abnormal (OR = 3.05, p = 0.036), having more than one TB symptom (OR = 3.42, p = 0.028) and presence of an alternative presumptive diagnosis (OR = 0.34, p = 0.023) were associated with having a sputum test ordered. High patient numbers, the inability to produce sputum, the unwillingness of moderately sick patients to provide sputum and the cost associated with chest X-rays were perceived as the challenges to further testing for TB.
Conclusion: Almost half of PLHIV with a positive TB screen test did not have a sputum test documented. This calls for instituting measures to address the barriers to TB screening among people living with HIV/AIDS for effective TB and HIV comorbidity management.