Visceral leishmaniasis & HIV co-infection in Bangladesh: Investigating prevalence and policy recommendations.

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BACKGROUND: Human Immunodeficiency Virus (HIV) co-infection has emerged as a significant challenge in implementing the World Health Organization's (WHO's) strategic interventions to eliminate visceral leishmaniasis (VL) in co-endemic countries. VL-HIV co-infection results in rapid deterioration, higher mortality, and substantially increases the risk of developing VL, facilitating parasite transmission. Although Bangladesh has received official validation for the elimination of VL as a public health problem in 2023, determining the prevalence of VL-HIV co-infection became imperative to develop effective strategies to sustain the elimination status. Therefore, in this study, we aimed to investigate the prevalence of HIV infection in VL patients in Bangladesh. METHODS: In this cross-sectional study, a total of 656 VL, post kala-azar dermal leishmaniasis (PKDL), and relapsed VL patients were enrolled. and tested for HIV following national HIV testing guidelines. Furthermore, the knowledge and attitudes of 624 participants were assessed through one-to-one interviews using structured questionnaires. FINDINGS: None of the patients tested positive for VL-HIV co-infection. Only 9.46% of respondents demonstrated comprehensive HIV/AIDS knowledge and 40.06% had positive attitudes towards individuals living with HIV/AIDS. Age, educational status, and home visits by government healthcare workers showed significant positive associations with participants' knowledge and attitudes in multivariate regression analysis. CONCLUSION: The study found no cases of HIV coinfection among the screened VL cohort in Bangladesh. However, the unavailability or response refusal of 26.1% of previous patients may have introduced significant selection bias. Therefore, considering the substantial health implications and increasing HIV incidence in the general population, we recommend continued routine HIV testing in all VL patients in Bangladesh, aligning with the WHO recommendations. Coordination between the respective national programs is warranted to develop effective strategies to detect emergence of such co-infected cases. FUNDING: This study was conducted with the financial support of the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR).

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