POPLINE Document Number: 314428
Author(s):
Wood R
Middelkoop K
Myer L
Grant AD
Whitelaw A
Source citation:
American Journal of Respiratory and Critical Care Medicine, 2007 Jan;175(1):87-93.
Abstract:
Although failure of tuberculosis (TB) control in sub-Saharan Africa is attributed to the HIV epidemic, it is unclear why the directly observed therapy short-course (DOTS) strategy is insufficient in this setting. We conducted a cross-sectional survey of pulmonary TB (PTB) and HIV infection in a community of 13,000 with high HIV prevalence and high TB notification rate and a well-functioning DOTS TB control program. Active case finding for PTB was performed in 762 adults using sputum microscopy and Mycobacterium tuberculosis culture, testing for HIV, and a symptom and risk factor questionnaire. Survey findings were correlated with notification data extracted from the TB treatment register. Of those surveyed, 174 (23%) tested HIV positive, 11 (7 HIV positive) were receiving TB therapy, 6 (5 HIV positive) had previously undiagnosed smear-positive PTB, and 6 (4 HIV positive) had smear-negative/culture-positive PTB. Symptoms were not a useful screen for PTB. Among HIV-positive and -negative individuals, prevalence of notified smear-positive PTB was 1,563/100,000 and 352/100,000, undiagnosed smear-positive PTB prevalence was 2,837/100,000 and 175/100,000, and case-finding proportions were 37 and 67%, respectively. Estimated duration of infectiousness was similar for HIV-positive and HIV-negative individuals. However,87% of total person-years of undiagnosed smear-positive TB in the community were among HIV-infected individuals. PTB was identified in 9% of HIV-infected individuals, with 5% being previously undiagnosed. Lack of symptoms suggestive of PTB may contribute to low case-finding rates. DOTS strategy based on passive case finding should be supplemented by active case finding targeting HIV-infected individuals. (author's)
Keywords:
South AfricaIndex page
Research Report
Surveys
Adults
HIV Infections
Pulmonary Effects
Tuberculosis
Testing
Prevalence
Prevention and Control
Treatment
Africa, Southern
Africa South of the Sahara
Africa
Developing Countries
Sampling Studies
Studies
Research Methodology
Age Factors
Population Characteristics
Demographic Factors
Population
Viral Diseases
Diseases
Physiology
Biology
Infections
Measurement
Medical Procedures
Medicine
Health Services
Delivery of Health Care
Health