HIV-TB co-infection

To determine the yield of tuberculosis (TB) and the prevalence of human immuno-deficiency virus (HIV) among key populations in the selected hotspot towns of Ethiopia, we undertook cross-sectional implementation research during August 2017-January 2018. A total of 1878 vulnerable people were screened. There was a statistically significant association of active TB cases with previous history of TB (Adjusted Odds Ratio (AOR): 11 95% CI, 4.06–29.81), HIV infection (AOR: 7.7 95% CI, 2.24–26.40), and being a health care worker (HCW). The prevalence of TB in key populations was nine times higher than 164/100,000 national estimated prevalence rate. The prevalence of HIV was five times higher than 1.15% of the national survey. The highest yield of TB was among HCWs and a high HIV burden was detected among female sex workers and internal migratory workers. These suggest the need for community and health facility based integrated and enhanced case finding approaches for TB and HIV in hotspot settings.

While old age is a known risk factor for developing active tuberculosis (TB), studies on TB in the population aged 60 years and older (considered elderly in this study) are few, especially in the developing world. Results of the TB prevalence survey in Uganda found high TB prevalence (570/100,000) in people over 65. We focused on treatment outcomes in the elderly to understand this epidemic better. We conducted a retrospective analysis of data from TB facility registers in Kampala City for the period 2014-2015. We analyzed the 2014-15 cohort with respect to age, sex, disease class, patients' human immunodeficiency virus (HIV) and directly observed therapy (DOT) status, type of facility, and treatment outcomes and compared findings in the elderly (≥60) and younger (<60) age groups. Of 15,429 records, 3.3% (514/15+,429) were for elderly patients. The treatment success rate (TSR) among elderly TB patients (68.3%) was lower than that of the non-elderly (80.9%) and the overall TSR 80.5%, (12,417/15,429) in Kampala. Although the elderly were less likely to test positive for HIV than the young, they had a two-fold higher risk of unfavorable treatment outcomes and were more likely to die while on treatment. However, there was no statistically significantly difference between treatment outcomes among HIV-positive and HIV-negative elderly TB patients. Compared to the younger TB patients, elderly TB patients have markedly poorer treatment outcomes, although TB/HIV co-infection rates in this age group are lower.

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.

The objective of this study was to assess the prevalence, profile and outcome of adverse events (AEs) associated with treatment of drug-resistant tuberculosis (DR-TB) and explore possible influences of HIV disease on the occurrence of adverse events. Data were collected from treatment records of all patients treated for DR-TB at the study facility between January 2008 and February 2010. A total of 141 adverse events of varying severity were experienced in 90% (53/59) of patients.The TB/HIV co-infection rate was 53%. The prevalence of gastrointestinal tract adverse events was 64%, tinnitus 45%, joint pain 28% and decreased hearing 25%. Abdominal pains, rash, nausea, decreased hearing and joint pain were more common in HIV infected than in HIV uninfected patients.

As HIV care services continue to scale-up in sub-Saharan Africa, adequate tuberculosis diagnostic capacity is vital to reduce mortality among HIV-infected persons.

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