{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T01:33:26Z","timestamp":1780104806468,"version":"3.54.0"},"reference-count":88,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T00:00:00Z","timestamp":1628035200000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001713","name":"European and Developing Countries Clinical Trials Partnership","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>AIDS\u2010mortality remains unacceptably high in sub\u2010Saharan Africa, largely driven by advanced HIV disease (AHD). We nested a study in an existing tuberculosis (TB) contact\u2010tracing intervention (Xpatial\u2010TB). The aim was to assess the burden of AHD among high\u2010risk people living with HIV (PLHIV) identified and to evaluate the provision of the WHO\u2010recommended package of care to this population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All PLHIV \u226514\u00a0years old identified between June and December 2018 in Manhi\u00e7a District by Xpatial\u2010TB were offered to participate in the study if ART na\u00efve or had suboptimal ART adherence. Consenting individuals were screened for AHD. Patients with AHD (CD4\u00a0&lt;\u00a0200\u00a0cells\/\u03bcL or WHO stage 3 or 4) were offered a package of interventions in a single visit, including testing for cryptococcal antigen (CrAg) and TB\u2010lipoarabinomannan (TB\u2010LAM), prophylaxis and treatment for opportunistic infections, adherence support or accelerated ART initiation. We collected information on follow\u2010up visits carried out under routine programmatic conditions for six months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 2881 adults were identified in the Xpatial TB\u2010contact intervention. Overall, 23% (673\/2881) were HIV positive, including 351 TB index (64.2%) and 322 TB contacts (13.8%). Overall, 159\/673 PLHIV (24%) were ART na\u00efve or had suboptimal ART adherence, of whom 155 (97%, 124 TB index and 31 TB\u2010contacts) consented to the study and were screened for AHD. Seventy percent of TB index\u2010patients (87\/124) and 16% of TB contacts (5\/31) had CD4\u00a0&lt;\u00a0200\u00a0cells\/\u00b5L. Four (13%) of the TB contacts had TB, giving an overall AHD prevalence among TB contacts of 29% (9\/31). Serum\u2010CrAg was positive in 4.6% (4\/87) of TB\u2010index patients and in zero TB contacts. All ART na\u00efve TB contacts without TB initiated ART within 48\u00a0hours of HIV diagnosis. Among TB cases, ART timing was tailored to the presence of TB and cryptococcosis. Six\u2010month mortality was 21% among TB\u2010index cases and zero in TB contacts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A TB contact\u2010tracing outreach intervention identified undiagnosed HIV and AHD in TB patients and their contacts, undiagnosed cryptococcosis among TB patients, and resulted in an adequate provision of the WHO\u2010recommended package of care in this rural Mozambican population. Same\u2010day and accelerated ART initiation was feasible and safe in this population including among those with AHD.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25775","type":"journal-article","created":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T14:35:52Z","timestamp":1628087752000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Improved detection and management of advanced HIV disease through a community adult TB\u2010contact tracing intervention with same\u2010day provision of the WHO\u2010recommended package of care including ART initiation in a rural district of Mozambique"],"prefix":"10.1002","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7437-8397","authenticated-orcid":false,"given":"Santiago","family":"Izco","sequence":"first","affiliation":[{"name":"ISGlobal, Hospital Cl\u00ednic\u2010Universitat de Barcelona Barcelona Spain"},{"name":"Centro de Investiga\u00e7\u00e3o em Saude 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