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: 2.013_MDG Impact of smear-negative results on tuberculosis outcome in HIV co-infected patients at a teaching hospital in Ghana Jeremy Mudd, Livia Jaramillo, Esther Kwara, Brandon Dale, Ernest Kwarteng, Nyonuku Akosua Baddoo, Audrey Forson, Margaret Lartey, Awewura Kwara; Warren Alpert Medical School of Brown University, Brown University, University of Maryland, University of Ghana Medical School Background: Tuberculosis (TB) causes death in one of four HIVinfected patients globally. Among HIV-infected patients, negative acid-fast bacilli (AFB) smear TB has been associated with higher death rate compared to patients with smear-positive TB in Malawi. We hypothesized that smear-negative results may account for high TB mortality in HIV-infected patients in Ghana. Methods: This retrospective study examined sputum smearnegative versus smear-positive pulmonary TB (PTB) patients seen at Korle-Bu Teaching Hospital Chest Clinic in Accra, Ghana from January 2010 to December 2014. Cases were sputum smear-negative TB patients with HIV and controls were sputum smear-positive TB patients with HIV. Inclusion criteria comprised diagnosis of TB and HIV within study period and age greater than 13 years. Patient characteristics were compared by Mann-Whitney Rank Sum Tests (continuous variables) and chi-square test (categorical variables). P-value < 0.05 was considered significant. Findings: PTB smear status was abstracted from records of 668 subjects. Of these subjects, 246 (36.8%) had sputum AFB-positive PTB, and 422 (63.2%) had sputum AFB-negative PTB. Overall, 23.8% of the subjects died. Patients with smear-negative PTB had higher median age (P1⁄40.029) and higher body weight (P1⁄40.021) compared to smear-positive subjects. A greater proportion of smear-negative patients presented with PTB for the first time, while smear-positive patients were more likely to relapse or return after previous treatment default (P<0.001). Extra-pulmonary involvement or disseminated TB were more likely to present with negative smear (P<0.001). There was no difference in treatment outcome between patients with smear-negative and smear-positive status in our study (P1⁄40.684). Interpretation: This study demonstrates high mortality for both smear-negative and smear-positive patients. However, unlike the Malawi study, smear status did not appear to influence treatment outcome. The high frequency of disseminated TB in smear-negative patients suggests that a high index of clinical judgment and other tests are needed for early diagnosis and treatment. Additional analysis is planned to understand the impact of HIV treatment on TB treatment outcome and whether that influenced the lack of association of smear results and outcomes. Funding: Infectious Disease Society of America Medical Scholars program, Brown University Scholarly Concentration, and Brown Minority Health and International Research Training. Abstract #: 2.014_MDG: 2.014_MDG Toward the implementation of universal health coverage: Introducing the partners in health’s-universal health

Toward the implementation of universal health coverage: Introducing the partners in health's-universal health coverage matrix