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. 2011 May;15(5):620-7.
doi: 10.5588/ijtld.10.0249.

Tuberculosis in HIV programmes in lower-income countries: practices and risk factors

L Fenner  1 , M Forster, A Boulle, S Phiri, P Braitstein, C Lewden, M Schechter, N Kumarasamy, M Pascoe, E Sprinz, D R Bangsberg, P S Sow, D Dickinson, M P Fox, J McIntyre, M Khongphatthanayothin, F Dabis, M W G Brinkhof, R Wood, M Egger; ART-LINC of IeDEA
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Tuberculosis in HIV programmes in lower-income countries: practices and risk factors

L Fenner et al. Int J Tuberc Lung Dis. 2011 May.

Abstract

Background: Tuberculosis (TB) is a common diagnosis in human immunodeficiency virus (HIV) infected patients on antiretroviral treatment (ART).

Objective: To describe TB-related practices in ART programmes in lower-income countries and identify risk factors for TB in the first year of ART.

Methods: Programme characteristics were assessed using standardised electronic questionnaire. Patient data from 2003 to 2008 were analysed and incidence rate ratios (IRRs) calculated using Poisson regression models.

Results: Fifteen ART programmes in 12 countries in Africa, South America and Asia were included. Chest X-ray, sputum microscopy and culture were available free of charge in respectively 13 (86.7%), 14 (93.3%) and eight (53.3%) programmes. Eight sites (53.3%) used directly observed treatment and five (33.3%) routinely administered isoniazid preventive treatment (IPT). A total of 19 413 patients aged ≥ 16 years contributed 13,227 person-years of follow-up; 1081 new TB events were diagnosed. Risk factors included CD4 cell count (>350 cells/μl vs. <25 cells/μl, adjusted IRR 0.46, 95%CI 0.33-0.64, P < 0.0001), sex (women vs. men, adjusted IRR 0.77, 95%CI 0.68-0.88, P = 0.0001) and use of IPT (IRR 0.24, 95%CI 0.19-0.31, P < 0.0001).

Conclusions: Diagnostic capacity and practices vary widely across ART programmes. IPT prevented TB, but was used in few programmes. More efforts are needed to reduce the burden of TB in HIV co-infected patients in lower income countries.

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Figures

Figure 1
Figure 1. Geographical distribution of HIV treatment programmes participating in the ART-LINC of IeDEA collaboration
Figures in brackets refer to TB incidence (any type of TB) per 100,000 population per year in 2006 (Source: World Health Organization). Colours indicate IeDEA regions.
Figure 2
Figure 2. Selection of study population
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