Prevalence and Predictors of Tuberculosis Coinfection among HIV-Seropositive Patients Attending the Aminu Kano Teaching Hospital,Northern Nigeria

Background

The HIV/AIDS epidemic has been accompanied by a severe epidemic of tuberculosis (TB), although the prevalence of coinfection is largely unknown, especially in developing countries, including Nigeria. The aim of this study was to determine the prevalence and predictors of TB coinfection among HIV-seropositive Nigerians.

Methods

The case files of HIV/AIDS patients attending Aminu Kano Teaching Hospital, Nigeria from January to December 2006 were reviewed.

Results

A total of 1320 HIV/AIDS patients had complete records and were reviewed, among which 138 (10.5%) were coinfected with TB (95% CI, 8.9% to 12.2%). Pulmonary TB was diagnosed in 103 (74.6%) patients, among whom only 18 (17.5%) were sputum-positive. Fifty (36.2%) coinfected patients had some type of extrapulmonary TB (EPTB); 15 had both pulmonary TB and EPTB. Among the 35 patients with EPTB only, 20 (57.1%) had abdominal TB, 5 (14.3%) had TB adenitis, 5 (14.3%) had spinal TB, 3 (8.6%) were being monitored for tuberculous meningitis, and 1 (2.9%) each had renal TB and tuberculous adrenalitis. The highest prevalence of TB, 13.7% (n = 28), was seen among patients aged 41–50 years. TB coinfection was significantly associated with marital status, WHO clinical stage, and CD4 count. Marital status (OR, 2.1; 95% CI, 1.28–3.59; P = 0.04), WHO clinical stage at presentation (4.81; 1.42–8.34; P = 0.001), and baseline CD4 count (2.71; 1.51–6.21; P = 0.02) remained significant predictors after adjustment for confounding.

Conclusions

The moderately high prevalence of TB among HIV-seropositive patients underscores the urgent need for strategies that lead to rapid identification and treatment of coinfection with active or latent TB.Key words: tuberculosis, HIV, coinfection, prevalence, Kano, Nigeria     

Severity of Outcomes Associated to Types of HIV Coinfection with TB and Malaria in a Setting Where the Three Pandemics Overlap

The objectives of this study is to (1) characterize profiles of HIV coinfection with TB and malaria; (2) estimate the severity of outcome associated with each type of coinfection; (3) identify most severe coinfection type, and populations most affected. Data on 1,302 HIV/AIDS patients were collected from hospital record books for 2007 and 2008. Distribution patterns of types of HIV coinfection with TB and malaria were assessed among low and high SES (socioeconomic status) inpatients. Case fatality rate for each type of coinfection was estimated as the ratio of number of deaths associated with a specific type of coinfection over the number of cases, times 100. Case fatality rates were compared among coinfection types and between low and high SES inpatients. Four types of coinfections were identified: single-HIV, HIV-TB, HIV-malaria and HIV-TB-malaria. Single-HIV infection was the most prevalent, and predominant among high SES inpatients; HIV-TB was the second most prevalent, and predominant among low SES inpatients; HIV-malaria and HIV-TB-malaria coinfections were the least prevalent, they were relatively comparable between both SES groups. HIV-TB coinfection was the deadliest type of coinfection, followed by HIV-TB-malaria and HIV-malaria. Single-HIV infection was the least deadly of the four conditions. Aside from HIV-malaria, the proportion of fatalities associated with each coinfection type was higher among low SES inpatients when compared with high SES inpatients. HIV/AIDS treatment and care programs in communities with limited resources and high prevalence of malaria and TB should give priority attention to low socioeconomic status patients coinfected with TB to prevent unnecessary deaths among those living with HIV.     

Surveillance of anti-tuberculosis drug resistance in the world: an updated analysis, 2007-2010

Objective

To present a global update of drug-resistant tuberculosis (TB) and explore trends in 1994–2010.

Methods

Data on drug resistance among new and previously treated TB patients, as reported by countries to the World Health Organization, were analysed. Such data are collected through surveys of a representative sample of TB patients or surveillance systems based on routine drug susceptibility testing. Associations between multidrug-resistant TB (MDR-TB) and human immunodeficiency virus (HIV) infection and sex were explored through logistic regression.

Findings

In 2007–2010, 80 countries and 8 territories reported surveillance data. MDR-TB among new and previously treated cases was highest in the Russian Federation (Murmansk oblast, 28.9%) and the Republic of Moldova (65.1%), respectively. In three former Soviet Union countries and South Africa, more than 10% of the cases of MDR-TB were extensively drug-resistant. Globally, in 1994 to 2010 multidrug resistance was observed in 3.4% (95% confidence interval, CI: 1.9–5.0) of all new TB cases and in 19.8% (95% CI: 14.4–25.1) of previously treated TB cases. No overall associations between MDR-TB and HIV infection (odds ratio, OR: 1.4; 95% CI: 0.7–3.0) or sex (OR: 1.1; 95% CI: 0.8–1.4) were found. Between 1994 and 2010, MDR-TB rates in the general population increased in Botswana, Peru, the Republic of Korea and declined in Estonia, Latvia and the United States of America.

Conclusion

The highest global rates of MDR-TB ever reported were documented in 2009 and 2010. Trends in MDR-TB are still unclear in most settings. Better surveillance or survey data are required, especially from Africa and India.     

Hepatotoxicity and Associated Risk Factors in HIV-Infected Patients Receiving Antiretroviral Therapy at Felege Hiwot Referral Hospital,Bahirdar, Ethiopia

Background

In Human Immunodeficiency Virus (HIV) infected patients on antiretroviral treatment (ART), hepatotoxicity is life threatening. Its outcome may lead to liver failure and death. This study was conducted to determine the rate and determinants of elevated alanine amino transferase (ALT) (referred as >40IU/L for both males and females).

Methods

A cross sectional study was conducted on HIV infected individuals who are on ART and suspected of drug resistance at Felege Hiwot Referral Hospital, Bahir Dar from July to December 2012. Venous bloods were collected from each patient and processed parallely to determine ALT, number of HIV RNAs, CD4 and CD8 T cells count, anti hepatitis C virus (HCV) and hepatitis B surface antigen.

Results

Out of 269 HIV infected patients receiving ART, 32% were confirmed of grades 1–4 levels of elevated ALT. The rate of severe hepatotoxicity (grade 3 and 4) was 1.84%. Patients with increased CD8 T cell counts (P=0.011; AOR=1.82; CI: 1.12 –2.54), alcohol over use (P=0.014; AOR = 1.23; CI: 1.36–3.29) and detectable HIV-1 RNA copies (P=0.015; AOR=2.07; CI: 1.15–3.74) independently predicts the elevation of ALT.

Conclusions

In HIV infected patients on ART, extreme elevations of ALT were infrequent but minor elevations were common so that patient-linked variables such as use of alcohol intake must be taken in to account for better clinical management of ART patients. The role of active HCV co-infection on the treatment outcome of ART should be further studied.     

Factors associated with tuberculosis as an AIDS-defining disease in an immigration setting

Background

Immigration can affect the evolution of TB as an AIDS-defining disease (AIDS–TB).

Methods

The Barcelona AIDS register for 1994–2005 was analyzed, and the global characteristics of AIDS–TB and AIDS–non-TB cases were compared. The Mantel-Haenszel test was used in the trend analysis, and logistic regression was used in the multivariate analysis.

Results

Of the 3600 cases studied, 1130 had both AIDS and TB. A declining trend in AIDS–TB rates was observed in both sexes among both immigrants and native residents. The percentage of AIDS–TB was significantly higher among immigrants (P = 0.02). The number of cases among immigrants remained constant over the period of study, but decreased among native residents. The sociodemographic and immunological characteristics associated with TB were male sex, age younger than 36 years, inner city residence, a record of incarceration, greater than 200 CD4+ T-cells/mm³, injecting drug use, heterosexual sex, and immigration from Latin America, the Caribbean, or sub-Saharan Africa.

Conclusions

The incidence of TB as an AIDS-defining disease decreased in Barcelona during a recent 10-year period in both native and immigrant populations. However, immigrants remain a high-risk group for AIDS–TB and should be targeted for surveillance and control of both diseases.Key words: epidemiology, AIDS, tuberculosis, immigration     

Tuberculosis treatment outcomes among hospital workers at a public teaching and national referral hospital in Kenya

Setting:

Kenyatta National Hospital (KNH), Nairobi, Ken-ya, a large referral and teaching hospital.

Objective:

1) To document tuberculosis (TB) case notification rates and trends; 2) to describe demographic, clinical and workplace characteristics and treatment outcomes; and 3) to examine associations between demographic and clinical characteristics, HIV/AIDS (human immunodeficiency virus/acquired immune-deficiency syndrome) treatment and anti-tuberculosis treatment outcomes among hospital workers with TB at KNH during the period 2006–2011.

Design:

A retrospective cohort study involving a review of medical records.

Results:

The TB case notification rate among hospital staff ranged between 413 and 901 per 100 000 staff members per year; 51% of all cases were extra-pulmonary TB; 74% of all cases were among medical, paramedical and support staff. The TB-HIV coinfection rate was 60%. Only 75% had a successful treatment outcome. Patients in the retreatment category, those with unknown HIV status and those who were support staff had a higher risk of poor treatment outcomes.

Conclusion:

The TB case rate among hospital workers was unacceptably high compared to that of the general population, and treatment outcomes were poor. Infection control in the hospital and management of staff with TB requires urgent attention.     

Exposing misclassified HIV/AIDS deaths in South Africa

Objective

To quantify the deaths from human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) that are misattributed to other causes in South Africa’s death registration data and to adjust for this bias.

Methods

Deaths in the World Health Organization’s mortality database were distributed among 48 mutually exclusive causes. For each cause, age- and sex-specific global death rates were compared with the average rate among people aged 65–69, 70–74 and 75–79 years to generate “relative” global death rates. Relative rates were also computed for South Africa alone. Differences between global and South African relative death rates were used to identify the causes to which deaths from HIV/AIDS were misattributed in South Africa and quantify the HIV/AIDS deaths misattributed to each. These deaths were then reattributed to HIV/AIDS.

Findings

In South Africa, deaths from HIV/AIDS are often misclassified as being caused by 14 other conditions. Whereas in 1996–2006 deaths attributed to HIV/AIDS accounted for 2.0–2.5% of all registered deaths in South Africa, our analysis shows that the true cause-specific mortality fraction rose from 19% (uncertainty range: 7–28%) to 48% (uncertainty range: 38–50%) over that period. More than 90% of HIV/AIDS deaths were found to have been misattributed to other causes during 1996–2006.

Conclusion

Adjusting for cause of death misclassification, a simple procedure that can be carried out in any country, can improve death registration data and provide empirical estimates of HIV/AIDS deaths that may be useful in assessing estimates from demographic models.     

Uptake of HIV testing and HIV positivity among presumptive tuberculosis patients at Puducherry,South India

Setting:

Puducherry, a district in South India with a low prevalence of human immunodeficiency virus (HIV) infection (<1% among antenatal women).

Objectives:

1) To estimate the proportion of patients with known HIV status who were HIV-positive, 2) to describe the demographic and clinical characteristics of patients with unknown HIV status among presumptive TB patients, and 3) to assess the additional workload at HIV testing centres.

Design:

In this cross-sectional study, consecutive presumptive TB patients attending microscopy centres for diagnosis during March–May 2013 were asked if they knew their HIV status. Patients with unknown HIV status were offered voluntary counselling and HIV testing.

Results:

Of 1886 presumptive TB patients, HIV status was ascertained for 842 (44.6%); 28 (3.3%) were HIV-positive. The uptake of HIV testing was significantly higher in younger age groups, males, residents of Puducherry and smear-positive TB patients. The median increase in the number of clients tested for HIV per day per testing centre was 1 (range 0–6).

Conclusion:

The uptake of HIV testing was low. HIV prevalence was higher among presumptive TB patients than in antenatal women, and as high as in TB patients. With minimal increase in workload at HIV testing centres, HIV testing could be implemented using existing resources.     

Lives saved by tuberculosis control and prospects for achieving the 2015 global target for reducing tuberculosis mortality

Objective

To assess whether the global target of halving tuberculosis (TB) mortality between 1990 and 2015 can be achieved and to conduct the first global assessment of the lives saved by the DOTS/Stop TB Strategy of the World Health Organization (WHO).

Methods

Mortality from TB since 1990 was estimated for 213 countries using established methods endorsed by WHO. Mortality trends were estimated separately for people with and without human immunodeficiency virus (HIV) infection in accordance with the International classification of diseases. Lives saved by the DOTS/Stop TB Strategy were estimated with respect to the performance of TB control in 1995, the year that DOTS was introduced.

Findings

TB mortality among HIV-negative (HIV−) people fell from 30 to 20 per 100 000 population (36%) between 1990 and 2009 and could be halved by 2015. The overall decline (when including HIV-positive [HIV+] people, who comprise 12% of all TB cases) was 19%. Between 1995 and 2009, 49 million TB patients were treated under the DOTS/Stop TB Strategy. This saved 4.6–6.3 million lives, including those of 0.23–0.28 million children and 1.4–1.7 million women of childbearing age. A further 1 million lives could be saved annually by 2015.

Conclusion

Improvements in TB care and control since 1995 have greatly reduced TB mortality, saved millions of lives and brought within reach the global target of halving TB deaths by 2015 relative to 1990. Intensified efforts to reduce deaths among HIV+ TB cases are needed, especially in sub-Saharan Africa.     

Community case management of childhood illnesses: policy and implementation in Countdown to 2015 countries

Objective

To explore the policies for, and implementation of, the community case management (CCM) of childhood illnesses in the 68 countries that were prioritized by the “Countdown to 2015” initiative in 2008.

Methods

In 2009–2010, community approaches concerning CCM policy and implementation, the roles of community health workers (CHWs) and the availability of medicines for the treatment of malaria, diarrhoea, pneumonia and neonatal infections were investigated by sending questionnaires to implementers and policy-makers and through telephone discussions with appropriate researchers and experts.

Findings

Of the 59 countries that responded, 81%, 75%, 54% and 14% had a policy for the CCM of diarrhoea, malaria, pneumonia and neonatal infections, respectively. Only three (6%) of the 53 malaria-endemic countries providing responses had policies for all four of these conditions, although 17 (32%) had CCM policies for malaria, diarrhoea and pneumonia. Some CCM of childhood illnesses was being implemented – more commonly for diarrhoea and malaria than for pneumonia or neonatal infections – in 88% of the countries providing responses. According to the responses received, CHWs administered the recommended treatments for diarrhoea, malaria or pneumonia in 34% (17/50), 100% (41/41) and 100% (34/34) of the countries implementing CCM of these conditions, respectively. Common programme concerns were drug supplies, quality of care and CHW incentives, training and supervision.

Conclusion

Despite progress, further efforts are needed towards policy reform and the expansion of CCM programmes. Ensuring the availability of recommended medicines and operational research, to assure quality, remain priorities.     

Anemia and Associated Factors Among Pregnant Women Attending Antenatal Care Clinic in Wolayita Sodo Town,Southern Ethiopia

Background

Anemia during pregnancy is a common problem which affects both the mother''s and her child''s health. The main aim of the study was to determine the prevalence and associated risk factors of anemia among pregnant women.

Methods

We conducted a facility based cross-sectional study on 363 pregnant women attending antenatal care clinic in Wolayita Soddo Otona Hospital from January to March 2014. Sociodemographic data were collected through questionnaire based interview. Four milliliter of venous blood and five grams of fecal samples were collected from each pregnant woman. Hematological parameters were determined using CELL DYN 1800^® (Abott, USA) Hematology analyzer. Stool samples were checked for intestinal parasites using both direct wet mount and formol-ether concentration techniques.Data were analyzed using SPSS version 20 software.

Results

Overall, the prevalence of anemia was 39.94% (95% CI: 34.7 – 45.2%), of which the majority (60%) had moderate anemia. The mean hemoglobin concentration was 11.55±2.97 g/dl. Age 15–24 years (AOR: 9.89, 95%CI:2.68–21.41), family size >5 (AOR:7.74, 95%CI:4.15–16.47), multigravida (AOR:2.66, 95%CI:1.1.31–4.53), having low income (AOR:5.81, 95%CI:2.93–14.11), current clinical illness (AOR: 6.38, 95%CI:3.13–13.00), intestinal parasitic infection (AOR:2.41, 95%CI:1.08–5.81), no history of contraceptive usage (AOR:5.02 95%CI:2.21–11.47), being in third trimesters (AOR:11.37, 95%CI:4.56–24.82), history of excess menstrual bleeding (AOR:9.82, 95%CI:3.27–21.35) and low body mass index (AOR:9.44, 95%CI:7.79–22.18) were identified as independent predictors of anemia among pregnant women.

Conclusion

Anemia prevalence was found out to be moderate public health importance. Identified risk factors should be considered for prevention and control of anemia among pregnant women.     

Willingness to participate in trials and to be vaccinated with new tuberculosis vaccines in HIV-infected adults

Background:

New tuberculosis (TB) vaccines are required to meet global targets for TB control.

Objectives:

To determine willingness to participate (WTP) in new TB vaccine trials, willingness to be vaccinated with a newly licensed TB vaccine and associated factors among human immunodeficiency virus (HIV) infected persons.

Setting:

Two primary care clinics in South Africa.

Design:

Cross-sectional study design. Participants were asked about WTP and willingness to be vaccinated. Demographic, clinical, knowledge of TB and perception of risk information were collected. Log binomial regression was used to determine associated factors.

Results:

A total of 827 participants were included in the analysis: 80.4% female, 72.2% on antiretroviral therapy, median age 35 years (interquartile range [IQR] 29–42 years), CD4 count 523 cells/µl (IQR 427–659 cells/µl). WTP and willingness to be vaccinated were high, at 84.5% and 92.6%, respectively. WTP was associated with knowledge about TB (prevalence ratio [PR] 1.10, 95% confidence interval [CI] 1.03–1.17) and perception of risk (PR 1.07, 95%CI 1.01–1.13). Willingness to be vaccinated was associated with employment (PR 1.04, 95%CI 1.01–1.08) and perception of risk (PR 1.05, 95%CI 1.01–1.09).

Conclusions:

There was high WTP in TB vaccine trials and willingness to be vaccinated among HIV-infected patients with good TB knowledge and high perceived risk of contracting TB.     

Timing of antiretroviral therapy and effects on tuberculosis treatment outcomes in HIV-co-infected patients in Malawi

Setting:

Queen Elizabeth Central Hospital, Blantyre, Malawi.

Objectives:

To determine 1) the proportion of human immunodeficiency virus (HIV) infected tuberculosis (TB) patients started on antiretroviral therapy (ART), 2) the timing of ART and 3) the effect of the timing on TB treatment outcomes.

Design:

A retrospective record review of HIV-infected TB patients registered from January to December 2009.

Results:

A total of 3376 TB patients were registered, of whom 2665 (79%) were HIV-tested and 2042 (77%) were HIV-infected. A total of 1190 HIV-infected TB patients who were not on ART at the time of starting TB treatment were studied. Of 688 (58%) who started ART, 61% started therapy within 2 months of anti-tuberculosis treatment and 39% started later (≥2 months). Treatment success for patients with TB who started ART within 2 months was higher than for those starting ART later (RR 1.6, 95%CI 1.4–1.8), and death rates were lower (RR 0.25, 95%CI 0.19–0.35).

Conclusion:

Under routine programme conditions in Malawi, a higher proportion of HIV-infected TB patients who started ART did so within 2 months of starting TB treatment, and early ART intervention was associated with better treatment outcomes. This confirms recommendations that co-infected TB patients should start ART early.     

Magnitude of Anemia and Associated Risk Factors among Pregnant Women Attending Antenatal Care in Shalla Woreda,West Arsi Zone,Oromia Region,Ethiopia

Background

Anemia during pregnancy is a common problem in developing countries and affects both the mother''s and her child''s health. The main objective of this study was to determine the prevalence of and the factors associated with anemia among pregnant women.

Methods

Facility based cross-sectional study design was conducted from June to August, 2011 on 374 pregnant women. Mothers who came for ANC during the study period and who met the inclusion criteria were interviewed and a capillary blood sample was taken. Hemoglobin level was determined by using HemoCue photometer, and interviewer administered questionnaire was used to collect data. Data were cleaned, coded and fed into SPSS version 16.0 for analysis.

Result

The mean hemoglobin concentration was 12.05±1.5 g/dl and prevalence of anemia was 36.6%. Family sizes (COR=2.67, CI (1.65, 4.32), third trimester (COR=1.45, CI (1.11, 2.23), meat consumption <1x/wk (COR=3.47, CI (1.58, 7.64) and pica (COR=2.33, CI (1.52, 3.58) were significantly associated with anemia. Having five or more children (AOR=5.2, CI [1.29, 21.09]), intake of vegetables and fruits less than once per day (AOR= 6.7, CI [2.49, 17.89]), intake of tea always after meal (AOR = 12.83.CI [45-28.9]), and recurrence of illness during pregnancy (AOR=7.3, CI [2.12–25.39]) were factors associated with anemia.

Conclusion

This study showed that anemia is a moderate public health problem. Less frequent meat and vegetable consumption, parity ≥5 are risk factors for anemia. Therefore, reducing parity, taking balanced diet and use of mosquito nets during pregnancy are recommended.     

Antiretroviral therapy uptake among adult tuberculosis patients newly diagnosed with HIV in Nyanza Province,Kenya

Setting:

In 2008, the Kenya tuberculosis (TB) program reported low (31%) antiretroviral therapy (ART) uptake among human immunodeficiency virus (HIV) infected TB patients.

Objective:

To confirm ART coverage and identify factors associated with HIV clinic enrollment and ART initiation among TB patients.

Design:

Retrospective chart abstraction of adult TB patients newly diagnosed with HIV and eligible for ART at 58 Nyanza Province TB clinics between October 2006 and April 2008. TB data were linked to HIV clinic data at 50 facilities that provided ART. Associations with HIV clinic enrollment and ART were evaluated.

Results:

Among 1137 ART-eligible TB patient records sampled, 32% documented HIV clinic enrollment and 29% ART. Date fields were largely incomplete; 11% of the patient records included HIV testing dates and ≤1% had dates for cotrimoxazole prophylaxis, HIV clinic enrollment and ART initiation. Adding HIV clinic data increased HIV clinic enrollment and ART documentation to respectively 62% and 44%. Among TB patients in HIV care, female sex, older age group and baseline CD4 documentation were associated with ART initiation.

Conclusion:

Linking data increased documentation of HIV clinic enrollment and ART uptake. Continued efforts are required to improve the documentation of HIV service delivery, especially in TB clinics. Interventions to increase ART uptake are needed for younger patients and men.     

ART uptake,its timing and relation to anti-tuberculosis treatment outcomes among HIV-infected TB patients

Setting:

All public health facilities in two provinces of Zimbabwe.

Objective:

To determine, among tuberculosis (TB) patients with human immunodeficiency virus (HIV) registered in 2010, 1) the proportion started on antiretroviral treatment (ART), 2) the timing of ART in relation to the start of anti-tuberculosis treatment, and 3) whether timing of ART influenced anti-tuberculosis treatment outcomes.

Design:

Retrospective cohort study.

Results:

Of the 2655 HIV-positive TB patients, 1115 (42%) were documented as receiving ART. Of these, 178 (16%) started ART prior to anti-tuberculosis treatment. Of those who started after anti-tuberculosis treatment, 17% started within 2 weeks, 43% between 2 and 8 weeks and 40% after 8 weeks. Treatment success in the cohort was 82%, with 14% deaths before completion of anti-tuberculosis treatment. Not receiving ART during anti-tuberculosis treatment was associated with lower anti-tuberculosis treatment success (adjusted RR 0.70, 95%CI 0.53–0.91) and more deaths (adjusted RR 3.43, 95%CI 2.2–5.36). There were no differences in TB treatment outcomes by timing of ART initiation.

Conclusion:

ART uptake is low given the improved treatment outcomes in those put on ART during anti-tuberculosis treatment. Better integration of HIV and TB services is needed to ensure increased coverage and earlier ART uptake.     

Multidrug-resistant tuberculosis in Belarus: the size of the problem and associated risk factors

Objective

To assess the problem of multidrug-resistant tuberculosis (MDR-TB) throughout Belarus and investigate the associated risk factors.

Methods

In a nationwide survey in 2010–2011, 1420 tuberculosis (TB) patients were screened and 934 new and 410 previously treated cases of TB were found to meet the inclusion criteria. Isolates of Mycobacterium tuberculosis from each eligible patient were tested for susceptibility to anti-TB drugs. Sociobehavioural information was gathered in interviews based on a structured questionnaire.

Findings

MDR-TB was found in 32.3% and 75.6% of the new and previously treated patients, respectively, and, 11.9% of the 612 patients found to have MDR-TB had extensively drug-resistant TB (XDR-TB). A history of previous treatment for TB was the strongest independent risk factor for MDR-TB (odds ratio, OR: 6.1; 95% confidence interval, CI: 4.8–7.7). The other independent risk factors were human immunodeficiency virus (HIV) infection (OR: 2.2; 95% CI: 1.4–3.5), age < 35 years (OR: 1.4; 95% CI: 1.0–1.8), history of imprisonment (OR: 1.5; 95% CI: 1.1–2.0), disability sufficient to prevent work (OR: 1.9; 95% CI: 1.2–3.0), alcohol abuse (OR: 1.3; 95% CI: 1.0–1.8) and smoking (OR: 1.5; 95% CI: 1.1–2.0).

Conclusion

MDR-TB is very common among TB patients throughout Belarus. The numerous risk factors identified for MDR-TB and the convergence of the epidemics of MDR-TB and HIV infection call not only for stronger collaboration between TB and HIV control programmes, but also for the implementation of innovative measures to accelerate the detection of TB resistance and improve treatment adherence.     

Treatment outcomes of new adult tuberculosis patients in relation to HIV status in Zimbabwe

Setting:

All public health facilities in Chitungwiza District, Zimbabwe.

Objective:

To determine, in new tuberculosis (TB) patients registered in 2009, 1) the proportion of persons human immunodeficiency virus (HIV) tested, stratified by age, sex and type of TB, and 2) treatment outcomes in relation to type of TB and HIV status.

Design:

Retrospective cohort study.

Results:

Of 1800 TB patients, 1100 (61%) were tested, of whom 877 (80%) were HIV-positive and 75 (9%) were documented as receiving antiretroviral treatment (ART). HIV testing and HIV positivity were similar between patients with different types of TB. Overall, the treatment success rate was 70%, and 17% had transferred out. Being HIV-positive on ART was associated with better treatment success and lower transfer out; age ≥55 years was associated with poor treatment success and higher death rates. Defaulting was more common in those who did not undergo smear testing or in extra-pulmonary TB patients, while deaths were higher in males.

Conclusion:

In a Zimbabwe district, less than two thirds of TB patients were tested. Better treatment success was observed in patients documented as HIV-positive and on ART. Important lessons for improved TB control include increasing HIV testing uptake for better access to ART, more comprehensive recording practices on ART and better reporting on true outcomes of transfer-out patients.     

Outcomes of isoniazid prophylaxis among HIV-infected children attending routine HIV care in Kenya

Setting:

Three human immunodeficiency virus (HIV) care clinics in Eastern Province, Kenya.

Objectives:

To establish rates of treatment completion, loss to follow-up, adverse drug reactions, tuberculosis (TB) disease and mortality among 606 HIV-infected children during 6 months of isoniazid preventive therapy (IPT).

Design:

Retrospective record review.

Results:

Of 606 HIV-infected children started on IPT, 556 (91.7%) successfully completed treatment, while 20 (3.3%) completed with interruptions. Cumulatively, 30 children (4.9%) did not complete IPT: 4 (0.7%) were lost to follow-up, 4 (0.7%) discontinued because of treatment interruptions, 2 (0.3%) developed adverse drug reactions, 1 developed a chronic cough, 1 was transferred to a non-IPT facility and 18 (3%) developed TB, including 2 who eventually died. TB disease was diagnosed in a median of 3 weeks (interquartile range [IQR] 2–16) post-IPT initiation. The median CD4 cell count for those aged 1–4 years who developed TB disease was 1023 cells/mm³ (IQR 375–1432), while for those aged 5–14 years it was 149 cells/mm³ (IQR 16–332). Isoniazid resistance was not detected in the four culture-confirmed TB cases.

Conclusion:

The high treatment completion, low loss to follow-up rate and few adverse drug reactions affirm the feasibility of IPT provision to children in HIV care clinics.