Management of TB in countries with high HIV prevalence.

Escott S; Nsutebu E; Walley J; Khan A
AFRICA HEALTH. 2001 Mar; 23(3):12-5.

The epidemics of HIV and tuberculosis (TB) are sweeping simultaneously across Africa. Low case detection rates and poor management of TB patients have led to many millions of people in the continent becoming infected with TB, and some with multi-drug resistant TB. It is noted that treating TB in HIV-infected patients is an extremely beneficial intervention for patients and for reducing the spread of TB. Although WHO-recommended strategies against TB are available, there is a need for case management guidelines to facilitate the implementation of the strategies. In response, collaborative efforts are being conducted to develop a TB/directly-observed treatment short course case-management desk-guide. This paper summarizes the main stages of the desk-guide that are of particular importance to practitioners. Focus is on the first six steps, as these are the most relevant to practitioners. These include: 1) identification; 2) diagnosing and categorizing; 3) prescribing drugs; 4) registering and educating patients; 5) organizing directly-observed therapy; and 6) managing close contacts. Moreover, particular emphasis is placed on the effect of HIV infection on the management of TB.

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