Systematic testing for HIV and tuberculosis among community members attending social drinking venues in Lusaka, Zambia

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There is a high prevalence of unhealthy alcohol use (UAU) in sub-Saharan Africa, especially among persons living with HIV (PWH). Persons with UAU are at greater risk of HIV acquisition, while PWH with UAU are more likely to not know their HIV status, not be engaged in care, and experience poor outcomes. UAU also portends to a substantially higher risk of tuberculosis (TB) disease, regardless of HIV status. Despite a higher risk of both HIV and TB among persons with UAU, the potential diagnostic yield of systematic testing for HIV and TB among individuals attending social drinking venues is largely unknown. Insight into the prevalence of undiagnosed HIV and TB among individuals attending social drinking values and the preferences of such persons, is crucial to understanding the potential acceptability, feasibility, and effectiveness of community-based strategies to improve detection and linkage to care for both HIV and TB. To address gaps in scientific understanding, we will undertake a cross-sectional study, nested within an ongoing NIH-funded study, among individuals attending social drinking venues in two urban townships with a high HIV and TB prevalence in Lusaka, Zambia. In Aim 1, among 400 patrons of social drinking venues, we will determine the prevalence of undiagnosed HIV, using a rapid oral-swab-based HIV antibody test, and pulmonary TB, using Xpert Ultra testing of sputum samples. For Aim 2, individuals attending social drinking venues (n=400) and owners/managers of such venues (n=20) will complete a best-worst scaling exercise to quantify their preferences for a hypothetical community-based, HIV and TB case-finding strategy to be undertaken at social drinking venues. The results of this study will directly inform an NIH R21 or R01 award application to evaluate a novel case-finding strategy to improve HIV and TB detection and care engagement among persons attending social drinking venues in Lusaka, Zambia.