{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T11:57:10Z","timestamp":1781611030801,"version":"3.54.5"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>HIV testing among people with presumptive tuberculosis (PP-TB) represents a critical entry point for HIV diagnosis and care, especially in high-burden settings like Mozambique. However, systematic testing in this population remains suboptimal. This study assessed gaps in HIV testing across the TB care cascade.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using programmatic data from clients screened for TB through community-based TB interventions in four high TB burden provinces from 2021 to 2023. Data was extracted from the registry books and triangulated with an electronic reporting system used by the national TB program. Descriptive analysis was conducted to identify drop-offs in HIV testing among PP-TB, particularly at three key stages: community screening, facility-based TB evaluation, and among confirmed TB clients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 4,607,257 clients screened, 52% were female, and 62% were aged 15 years and older. Of those screened, 9% (415,654) were identified as PP-TB from whom 85% (351,255) were referred to health facilities, 97% (341,049) successfully completed referrals, and 96% (326,664) were further evaluated for TB. Of those evaluated, 24% (77,584) were diagnosed with TB and 85% were notified and initiated anti-TB treatment. Three levels of gaps in HIV testing were identified: (i) HIV testing omission, no evidence of concurrent HIV testing was documented at community level \u2013 community TB lay staff not allowed to perform HIV testing; (ii) HIV testing gap among TB-negative clients, 76% were not tested for HIV, despite their presumptive TB status; (iii) HIV testing deficiency among confirmed TB clients, 14% of these confirmed TB remained with unknown HIV status. Combining these sequential testing failures, the estimated overall gap in HIV testing among PP-TB reached 84%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HIV testing integration into TB care cascade remains limited in Mozambique, with substantial missed opportunities at the community level, among TB-negative clients, and even among confirmed TB clients. Strengthening HIV testing as a systematic component of TB screening, especially in outreach context, could enhance early diagnosis, linkage to care, and co-infection management. These findings call for urgent policy and operational adjustments to close the gaps in HIV testing, particularly within the community-based TB services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-025-11545-7","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T10:07:57Z","timestamp":1758881277000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gaps in HIV testing among people with presumptive TB in Mozambique: a 3-year retrospective cohort study"],"prefix":"10.1186","volume":"25","author":[{"given":"Guita","family":"Amane","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Simbine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pereira","family":"Zindoga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Algy","family":"Abdula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguelhete","family":"Lisboa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"11545_CR1","unstructured":"World Health Organization (WHO). Global tuberculosis report 2023. World Health Organization. 2023. Available at https:\/\/www.who.int\/teams\/global-tuberculosis-programme\/tb-reports\/global-tuberculosis-report-2023"},{"key":"11545_CR2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3656-x","author":"M Lisboa","year":"2019","unstructured":"Lisboa M, Fronteira I, Colove E, Nhamonga M, Martins MD. Time delay and associated mortality from negative smear to positive Xpert MTB\/RIF test among TB\/HIV patients: a retrospective study. BMC Infect Dis. 2019. https:\/\/doi.org\/10.1186\/s12879-018-3656-x. 19:1\u2009\u2013\u20090.","journal-title":"BMC Infect Dis"},{"issue":"4","key":"11545_CR3","doi-asserted-by":"publisher","first-page":"e225","DOI":"10.1016\/S2352-3018(21)00023-0","volume":"8","author":"G Chamie","year":"2021","unstructured":"Chamie G, Napierala S, Agot K, Thirumurthy H. HIV testing approaches to reach the first UNAIDS 95% target in sub-Saharan Africa. Lancet HIV. 2021;8(4):e225\u201336. https:\/\/doi.org\/10.1016\/S2352-3018(21)00023-0.","journal-title":"Lancet HIV"},{"key":"11545_CR4","unstructured":"World Health Organization (WHO). WHO policy on collaborative TB\/HIV activities: guidelines for national programmes and other stakeholders. World Health Organization. 2012. Available at https:\/\/www.who.int\/publications\/i\/item\/9789241503006"},{"key":"11545_CR5","unstructured":"World Health Organization (WHO). Consolidated guidelines on HIV testing services. 2019. World Health Organization; 2020. https:\/\/iris.who.int\/handle\/10665\/336323"},{"key":"11545_CR6","unstructured":"World Health Organization (WHO). Consolidated guidelines on differentiated HIV testing services. World Health Organization; 2024. https:\/\/www.who.int\/publications\/i\/item\/9789240096394."},{"key":"11545_CR7","unstructured":"Odhiambo J, Kizito W, Njoroge A, Wambua N, Nganga L, Mburu M et al. Provider-initiated HIV testing and counselling for TB patients and suspects in Nairobi, Kenya. The International Journal of Tuberculosis and Lung Disease. 2008;12(3): S63-8. https:\/\/www.ingentaconnect.com\/content\/iuatld\/ijtld\/2008\/00000012\/A00103s1\/art00012"},{"issue":"1","key":"11545_CR8","first-page":"38","volume":"25","author":"AA Adjei","year":"2006","unstructured":"Adjei AA, Adiku TK, Ayeh-Kumi PF, Hesse IF. Prevalence of human immunodefiency virus infection among tuberculosis suspect patients in Accra, Ghana. West Afr J Med. 2006;25(1):38\u201341.","journal-title":"West Afr J Med"},{"issue":"4","key":"11545_CR9","doi-asserted-by":"publisher","first-page":"459","DOI":"10.5588\/ijtld.10.0353","volume":"15","author":"A Porskrog","year":"2011","unstructured":"Porskrog A, Bjerregaard-Andersen M, Oliveira I, Joaqu\u00edm LC, Camara C, Andersen PL, et al. Enhanced tuberculosis identification through 1-month follow-up of smear-negative tuberculosis suspects. Int J Tuberc Lung Dis. 2011;15(4):459\u201364.","journal-title":"Int J Tuberc Lung Dis"},{"issue":"2","key":"11545_CR10","first-page":"168","volume":"11","author":"P Srikantiah","year":"2007","unstructured":"Srikantiah P, Lin R, Walusimbi M, Okwera A, Luzze H, Whalen CC, et al. Elevated HIV Seroprevalence and risk behavior among Ugandan TB suspects: implications for HIV testing and prevention. Int J Tuberc Lung Dis. 2007;11(2):168\u201374. https:\/\/www.ingentaconnect.com\/content\/iuatld\/ijtld\/2007\/00000011\/00000002\/art00010.","journal-title":"Int J Tuberc Lung Dis"},{"issue":"11","key":"11545_CR11","first-page":"1442","volume":"14","author":"A Deribew","year":"2010","unstructured":"Deribew A, Negussu N, Kassahun W, Apers L, Colebunders R. Uptake of provider-initiated counselling and testing among tuberculosis suspects. Ethiopia Int J Tuberculosis Lung Disease. 2010;14(11):1442\u20136. https:\/\/www.ingentaconnect.com\/content\/iuatld\/ijtld\/2010\/00000014\/00000011\/art00014.","journal-title":"Ethiopia Int J Tuberculosis Lung Disease"},{"key":"11545_CR12","unstructured":"Minist\u00e9rio da Sa\u00fade (MISAU). Relat\u00f3rio anual 2023: Programa Nacional de Controlo da Tuberculose, Maputo, Mo\u00e7ambique; 2024. (Annual Tuberculosis Report 2023: National TB Program, Maputo, Mozambique;. 2024)."},{"key":"11545_CR13","unstructured":"World Health Organization (WHO). Mozambique - a comprehensive community-based service delivery intervention for TB: case study. World Health Organization; 2020 Oct. p. 16."},{"key":"11545_CR14","unstructured":"The US. President\u2019s Emergency Plan for AIDS Relief (PEPFAR). Fiscal year 2024 technical considerations within PEPFAR 2023 Country and Regional Operational Plan. COP\/ROP) Guidance for all PEPFAR-Supported Countries; 2023."},{"key":"11545_CR15","unstructured":"Instituto Nacional de Estat\u00edstica (INE). Projec\u00e7\u00f5es da popula\u00e7\u00e3o 2017\u20132050 por prov\u00edncias. 2023. Available at https:\/\/www.ine.gov.mz\/web\/guest\/censo-2017"},{"issue":"10","key":"11545_CR16","doi-asserted-by":"publisher","first-page":"48","DOI":"10.5588\/ijtld.13.0173","volume":"17","author":"J Uwimana","year":"2013","unstructured":"Uwimana J, Zarowsky C, Hausler H, Swanevelder S, Tabana H, Jackson D. Community-based intervention to enhance provision of integrated TB-HIV and PMTCT services in South Africa. Int J Tuberc Lung Dis. 2013;17(10):48\u201355.","journal-title":"Int J Tuberc Lung Dis"},{"issue":"12","key":"11545_CR17","doi-asserted-by":"publisher","first-page":"e0165614","DOI":"10.1371\/journal.pone.0165614","volume":"11","author":"JA Gilbert","year":"2016","unstructured":"Gilbert JA, Shenoi SV, Moll AP, Friedland GH, Paltiel AD, Galvani AP. Cost-effectiveness of community-based TB\/HIV screening and linkage to care in rural South Africa. PLoS One. 2016;11(12):e0165614.","journal-title":"PLoS One"},{"issue":"5","key":"11545_CR18","doi-asserted-by":"publisher","first-page":"e0126267","DOI":"10.1371\/journal.pone.0126267","volume":"10","author":"JA Gilbert","year":"2015","unstructured":"Gilbert JA, Long EF, Brooks RP, Friedland GH, Moll AP, Townsend JP, Galvani AP, Shenoi SV. Integrating community-based interventions to reverse the convergent TB\/HIV epidemics in rural South Africa. PLoS One. 2015;10(5):e0126267.","journal-title":"PLoS One"},{"key":"11545_CR19","doi-asserted-by":"publisher","unstructured":"Steingart KR, Sohn H, Schiller I, Kloda LA, Boehme CC, Pai M, Dendukuri N. Xpert\u00ae MTB\/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev. 2013;Issue 1. Art. No.: CD009593. https:\/\/doi.org\/10.1002\/14651858.CD009593.pub2. https:\/\/www.cochranelibrary.com\/cdsr\/doi\/10.1002\/14651858.CD009593.pub2\/full.","DOI":"10.1002\/14651858.CD009593.pub2"},{"key":"11545_CR20","unstructured":"Van Rompaey S, De Schacht C, Paulo P, Fernando AN, Langa J, Ambelikola A, Tadeu B, Rafael C, Wester CW. Evaluation of access to tuberculosis (TB) and HIV testing and treatment services among patients with presumptive TB (Technical assessment report). Mozambique: Friends in Global Health;\u00a02021. https:\/\/drive.google.com\/file\/d\/1ZvfYWEJYBRyY7LQb_MIkHMmFfHNLtS7q\/view?usp=sharing."},{"issue":"6","key":"11545_CR21","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1177\/2325957413488183","volume":"13","author":"K Frasca","year":"2014","unstructured":"Frasca K, Cohn J. Integration of HIV and tuberculosis in the community. Journal of the International Association of Providers of AIDS Care (JIAPAC). 2014;13(6):534\u20138.","journal-title":"Journal of the International Association of Providers of AIDS Care (JIAPAC)"},{"key":"11545_CR22","unstructured":"World Health Organization (WHO). Mozambique - A comprehensive community-based service delivery intervention for TB: case study. World Health Organization. 2020 Oct 16. https:\/\/iris.who.int\/bitstream\/handle\/10665\/337105\/9789240013575-eng.pdf"},{"issue":"8","key":"11545_CR23","doi-asserted-by":"publisher","first-page":"e1001496","DOI":"10.1371\/journal.pmed.1001496","volume":"10","author":"AB Suthar","year":"2013","unstructured":"Suthar AB, Ford N, Bachanas PJ, Wong VJ, Rajan JS, Saltzman AK, Ajose O, Fakoya AO, Granich RM, Negussie EK, Baggaley RC. Towards universal voluntary HIV testing and counselling: a systematic review and meta-analysis of community-based approaches. PLoS Med. 2013;10(8):e1001496. https:\/\/journals.plos.org\/plosmedicine\/article?id=10.1371\/journal.pmed.1001496.","journal-title":"PLoS Med"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-025-11545-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-025-11545-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-025-11545-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T11:48:29Z","timestamp":1781610509000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12879-025-11545-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,26]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["11545"],"URL":"https:\/\/doi.org\/10.1186\/s12879-025-11545-7","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,26]]},"assertion":[{"value":"26 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol was reviewed and approved by the institutional bioethics committee for health of the Higher Institute of Health Sciences of Maputo (\n                      Instituto Superior de Ci\u00eancias de Sa\u00fade\n                      - ISCISA), Mozambique under registration code TFC-MEPS-ML-04\/22. The study adhered to the ethical principles outlined in the Declaration of Helsinki (2013 revision). As the study involved de-identified data, the requirement for informed consent was waived by the above-mentioned institutional review board.A formal letter was written from ISCISA to the Ministry of Health (MoH), and then the MoH also wrote a letter to the Provincial Health Services Directorates. The study was carried out after permission was obtained from the provincial, district, and health facilities managers. In addition, the whole objective, risks, burdens, and benefits of the study was briefly explained to those managers as voluntarily asked to provide the right to access the registry books and electronic reporting system used by the national TB program. Finally, the confidentiality and anonymity of the data were secured.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1164"}}