# Linkage to TB and HIV care for persons who smoke illicit drugs: a prospective cohort study

## TL;DR

This study examines how people who use drugs in South Africa link to HIV and TB care, finding better success with TB treatment than HIV.

## Contribution

The study provides empirical evidence on care linkage disparities for people who use drugs in a high HIV/TB burden setting.

## Key findings

- Linkage to TB care was higher (78%) compared to HIV care (57% for previously diagnosed and 42% for newly diagnosed).
- Only 23% of people with HIV were retained on antiretroviral therapy six months after referral.
- 56% of participants with TB had a favorable treatment outcome.

## Abstract

Linking people diagnosed with TB and HIV into care is critical. However, many barriers exist to care linkage, especially for people who use drugs (PWUD).

Characterise differences in TB and HIV care linkage among PWUD in a high-TB/HIV-burden setting.

We analysed HIV and TB linkage to care among PWUD who were diagnosed with HIV and/or TB in a prospective study in Worcester, South Africa. We compared care cascades between participants diagnosed with HIV, TB, or both.

Among 750 participants screened in the community for HIV and TB, we diagnosed and referred 81 individuals with newly diagnosed (N = 39) or previously diagnosed but untreated (N = 42) HIV, as well as 64 individuals with newly diagnosed TB; 11 of these individuals had HIV/TB co-infection. Linkage was higher for TB care (78%) than HIV care (57% for previously diagnosed and 42% for newly diagnosed). 56% of participants with TB had a favourable treatment outcome, whereas only 23% of people with HIV were retained on antiretroviral therapy 6 months after referral.

While many PWUD successfully linked to TB and HIV care, disparities exist between the two cascades in this setting. Systems improvements are needed to facilitate linkage and retention for high-risk populations.