TB-HIV co-infection

Our objective was to demonstrate the feasibility of integrated care for TB, HIV and diabetes mellitus (DM) in a pilot project in Ethiopia. Of 3439 study participants, 888 were patients with DM, 439 patients with TB and 2112 from HIV clinics. Tri-directional screening was feasible for detecting and managing previously undiagnosed TB and DM.

Retreatment ‘others’ refer to all TB cases who were previously treated but with unknown outcome of that previous treatment or who have returned to treatment with bacteriologically negative pulmonary or extra-pulmonary TB. This study was conducted in 11 regional referral hospitals (RRHs) serving high burden TB districts in Uganda to determine the profile and treatment success of TB retreatment ‘others’ in comparison with the classical retreatment cases. Of the 6244 TB cases registered at the study sites, 733 (11.7 %) were retreatment cases. Retreatment ‘others’ constituted 45.5 % of retreatment cases. Co-infection with HIV was higher among retreatment ‘others’ (70.9 %) than classical retreatment cases (53.5 %). Treatment was successful in 410 (56.2 %) retreatment cases. Retreatment ‘others’ were associated with reduced odds of success compared to classical cases. There is a need to review the diagnosis and management of retreatment ‘others’.

Increasing coverage of isoniazid preventive therapy and cotrimoxazole preventive therapy reduced risk of TB among HIV patients who started treatment. All people living with HIV should be screened for TB, but for patients who have advanced disease (WHO clinical stage III/IV, bedridden, and with hemoglobin level of 10 mg/dl), intensified screening is highly recommended during treatment follow-up.

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