Tuberculosis treatment and factors associated with unsuccessful tuberculosis treatment outcome among TB/HIV co-infected patients in Rwanda: A retrospective cohort study

Introduction Mycobacterium tuberculosis remains the main cause of death as an infectious agent of Tuberculosis in humans, particularly in resource-poor settings. Worldwide, Tuberculosis is one of the top 10 causes of mortality. Objective of the study This study aims to determine the outcomes of TB treatment and assess the factors associated with unsuccessful TB treatment outcome among TB/HIV co-infected patients in Rwanda. Methods This was a retrospective cohort study of all TB/HIV co-infected patients reported in the national electronic TB reporting system (e-TB) by all health facilities from July 2019 to June 2020. Frequencies, proportions, bivariate and multivariate logistic regression were performed to determine factors associated with unsuccessful TB treatment. Results There were 1,144 people reported in the e-TB, however, only 987 were included in the study because 157 patients did not meet the inclusion criteria.The TB/HIV coinfected patients who were not given nutritional support, OR 7.3, 95%CI [1.4, 37.6] and those who were not on ART,OR15.3, 95%CI [3.6, 69.6],were more likely to have unsuccessful treatment outcome than their counterparts. Conclusion Unsuccessful TB treatment outcomes were highly observed among TB/HIV coinfected patients. The study recommended reinforcing nutritional support and early initiation of ART among TB/HIV co-infected patients.

Política terapéutica de la coinfección por M. tuberculosis y el VIH / Therapeutic policy of coinfection by M. tuberculosis and HIV

La tuberculosis (TB) es la infección oportunista más frecuente en pacientes infectados por el VIH, con impactos bidireccionales en el paciente: al aumentar la carga viral, la TB acelera la progresión de la infección por VIH a SIDA y, con ello, a la muerte. A su vez, El VIH dificulta el diagnóstico y tratamiento de la TB y favorece el desarrollo de diversas complicaciones clínicas. Al considerar que (1) sólo las dos terceras partes de la población seropositiva en el mundo tienen acceso a terapia antiretroviral; que (2) la tercera parte de fallecidos por SIDA en 2019 estaban también diagnosticados con TB; que (3) a nivel global el riesgo de morir por TB se duplica en el individuo con diagnóstivo de VIH positivo; y que (4) en las Américas, únicamente el 61% de las personas con TB-VIH reciben tratamiento antiretroviral, dejando tres veces más muertes y dos veces más pérdida en el seguimiento en los coinfectados, se evidencia una realidad preocupante sobre los resultados de las actuales políticas de tratamiento para la coinfección TB-VIH, haciendo necesario explorar sus bases, alcance, y metodologías en América y en Ecuador(AU)

Tuberculosis (TB) is the most frequent opportunistic infection in HIV-infected patients, with two-way impacts on the patient: by increasing the viral load, TB accelerates the progression from HIV infection to AIDS and, with it, to the death. In turn, HIV makes the diagnosis and treatment of TB difficult and favors the development of various clinical complications. Considering that (1) only two thirds of the HIV-positive population in the world have access to antiretroviral therapy; that (2) a third of those who died from AIDS in 2019 were also diagnosed with TB; that (3) globally, the risk of dying from TB is doubled in the individual with a positive HIV diagnosis; and that (4) in the Americas, only 61% of people with TB-HIV receive antiretroviral treatment, leaving three times more deaths and two times more loss to follow-up in those who are coinfected, there is a worrying reality about the results of current treatment policies for TB-HIV coinfection, making it necessary to explore its bases, scope, and methodologies in America and Ecuador(AU)

A Study of HIV-TB Co-infection and its Determinants at a Tertiary Care Hospital in Goa

Introduction: Since the discovery of HIV in the 1980's,there has been an alarming upsurge of Tuberculosis acrossthe globe. TB is the most common and usually the firstopportunistic infection in people living with HIV. BothHIV and TB together form the cursed duet, each one fastforwarding the progression of the other. Aims & Objectives:To study the epidemiology & various determinants of HIV-TBco-infection in HIV positive patients attending ART center atGoa Medical College (GMC), Goa. To study the prevalence ofHIV- TB co-infection. Settings and Design: It was a three yearrecord based retrospective observational study carried out atthe antiretroviral therapy center of a tertiary care Hospital inthe state of Goa.Material and methods: Study group comprised of 342 casesof HIV-TB co-infected patients above 15 years of age, and thecontrol group was formed by equal number of non TB, HIVinfected patients diagnosed during the same period. Variousdeterminants like age, gender, occupation, educational status,mode of transmission of HIV, addictions, CD4 counts etcwere compared. Statistical analysis: was done by calculatingpercentages and proportion by SPSS 14.0 version and Chisquare test was used for statistical significance, with P valuesless than 0.05 considered as statistically significant.Results: The prevalence of HIV-TB co-infection during thestudy period was found to be 26.6%. The incidence of coinfection was found to be higher in males (60.8%), in thosewho were semiskilled workers and with level of education upto secondary school and all these were found to be statisticallysignificant. Alcohol consumption, low CD4 counts and Comorbid illness like anemia were also found to be statisticallysignificant.Conclusions: Higher HIV-TB co-infection prevalence ratein the state warrants upgradation of disease control programswith efforts to increase awareness about the prevention andspread of both the diseases and their effective management.

Adherence to Isoniazid Preventive Therapy (IPT) among Children in Close Contact with Adult Pulmonary Tuberculosis (PTB) Patients

Introduction:Tuberculosis (TB) is among the top ten leading cause of morbidity and mortality globally, and studies have shown that adherence to a six Month course of Isoniazid Preventive Therapy (IPT) reducesthe incidence of TB disease in HIV-negative/positive populations at risk of developing active TB disease.Objective:This study was carried out to identify active TB cases among children aged 0-5 years who are in close contact with adult cases of pulmonary TB (PTB), to determine the adherence rate to IPT among these close contacts thatdo not have active TB and to identify factors associated with non adherence if any. Methodology: This study was a prospective descriptive study carried out in Rivers state,Nigeria in two health facilities that offers services for TB diagnosis and treatment.Ethical approval for the study was obtained from the Rivers State Ministry of Health while verbal consent was obtained from the parents/caregivers of the children. Children aged 0-5 years who were in close contact with newly diagnosed PTB cases were recruited for the study. They were screened for HIV and evaluated for TB using clinical features and standard laboratory investigations. Those without active TB disease were commenced on isoniazid preventive therapy (IPT) for six months at a daily dose of 5mg/kg after adherence counselling and followed up at the health centres. Obtained data was analysed using Epi Info Version 7.2.3.1statistical software. Descriptive statistics was used while the test for association between variables was done with chi-square test at p ≤ 0.05 level of significance. Frequency tables were used for presentation of results.Results: A total of Sixty three children were recruited for the study 37 (58.7%) were males while 26 (41.3%) were females. Thirty two (50.8%) were children of index PTB patients while 29 (46.1%) belonged to lower socio-economic class. Their age ranged from 4 months to 4 years with a mean age of 2.84years ±1.27years. Six (16.2%) out of the 37 males and 2 (7.7%) out of the 26 females were confirmed to have active TB, giving a TB prevalence of 12.7%. The gender difference was not statistically significant (p= 0.32). Of the fifty five children that commenced INH in the first Month, only twenty four of them completed the six Month course of INH, giving an IPT adherence rate of 49.6%. Identified reasons for non adherence includes ‘My child is not sick’, ‘No transport Money’, ‘My child is writing exams”.“My child is tired of the drugs”, “the Health workers are not friendly’ and ‘long waiting time before collecting medications”.Conclusion: Early contact tracing is important for early detection of TB cases in children. Adherence to IPT in this study is low and strategies like community tracing of defaulters using trained social workers and community nurses as well as use of well-supervised and convenient ambulatory treatment centres that are manned by trained lower cadre health staff can improve adherence.

Os determinantes da mortalidade por Tuberculose e TB-HIV no Sul do Brasil: Da abordagem espacial à análise de sobrevida / The determinants of tuberculosis and HIV-TB mortality in Southern Brazil: From the spatial approach to the survival analysis

O estudo teve como objetivo analisar os determinantes sociais da saúde associados à mortalidade por TB e verificar as mortes precoces ocorridas por TB e TB/HIV e seus fatores associados, por meio de duas abordagens: uma de base ecológica e uma de base individual, utilizando análise espacial e de sobrevida. O estudo foi realizado na capital do Paraná, Curitiba; e, para análise espacial, foram consideradas as 148 unidades de desenvolvimento humano (UDH). A população de estudo foi composta dos casos de mortes por TB como causa básica (CID 15-19). Para análise de sobrevida, foram acrescidos os casos de mortes pela coinfecção TB/HIV (CID 20.0). Os dados foram obtidos do Sistema de Informação sobre Mortalidade (SIM) e do Sistema de Informações sobre Doenças de Notificação (SINAN) referentes ao período 2008 a 2015. As Unidades de Desenvolvimento Humano foram caracterizadas de acordo com a mortalidade por TB e com as variáveis dos determinantes sociais da saúde. Inicialmente os casos de óbitos por TB foram geocodificados e calculadas taxas de mortalidade bruta, taxa Bayesiana e investigados quanto à autocorrelação espacial e existência de aglomerados de risco por meio da técnica de varredura espacial e obtidos riscos relativos espaciais. Para correlacionar as áreas de risco espacial para mortalidade por TB foi utilizada a regressão logística, tendo como variável dependente área de risco: sim e não, e após avaliado com uso da curva ROC, também foi elaborado um mapa de sobreposição de áreas de risco dos determinantes sociais da saúde e correlacionados com aglomerados de risco para mortalidade. Por último, para investigar as mortes precoces por TB e TB/HIV e fatores associados foi utilizada a técnica de Kaplan-Meier e Regressão de Cox. Foram identificados 131 óbitos por TB, dos quais 126 (96,2%) foram geocodificados e 05 (4,8%) foram excluídos devido a endereços incompletos. Para a primeira fase, foram calculadas as taxas resultado em taxa média bruta de 1,07/100.000 habitantes. As mortes estiveram distribuídas de maneira difusa, porém, com maior concentração nas regiões periféricas e sul do município. Foi detectado um aglomerado espacial de risco na região sul para mortalidade por TB e para variáveis dos determinantes sociais da saúde, sendo onde as piores condições foram detectadas. O estudo confirmou a relação entre os determinantes sociais e as áreas de risco de mortes por TB quando relacionados com a Dimensão 1 extraída com (OR= 0,093; IC95% 0,34-0,25). O mapa de sobreposição dos aglomerados de risco relacionados com aglomerado para mortalidade por TB resultou em um OR= 5,98 (IC95%: 2,41-14,49) e curva ROC= 0,865; IC95%=0,796-0,934. Na segunda fase, ao analisar as mortes precoces por TB, foi encontrada uma mediana de dias sobrevividos de 22 dias, sendo que 88 (59,1%) dos pacientes morreram até 30 dias após o diagnóstico e 107 (72,5%) após 60 dias (mínimo: 1, máximo: 349, D.P: 68,8 e média: 50 dias). Dentre os 179 óbitos analisados, 105 (58,6%) óbitos tinham diagnóstico de TB (CID 15.0-19) e 74 (41,4%) óbitos a coinfecção TB/HIV (CID 20.0). A maioria dos casos ocorreu em pessoas do sexo masculino, 138 (77,1%), da raça/ cor branca predominante 120 (67%) e a média de idade foi de 47 anos (mínimo:20, máximo: 94, mediana: 44, DP: 14). Os resultados corroboram com a necessidade de melhorias múltiplas nas condições de vida da população, com enfoque nas regiões mais vulneráveis (áreas de aglomerados de risco espacial) identificadas e políticas específicas para prevenção do uso de álcool, diante da identificação deste fator associado às mortes precoces

The objective of the study was to analyze the social determinants of health associated with TB mortality and to verify the early deaths caused by TB and TB / HIV and their associated factors, through two approaches: one based on an ecological basis and an individual basis using analysis spatial and survival The study was carried out in the capital of Paraná, Curitiba; and for spatial analysis, the 148 human development units (UDH) were considered. The study population was composed of cases of TB deaths as the underlying cause (ICD 15-19). Survival analysis included cases of TB / HIV coinfection deaths (ICD 20.0). Data were obtained from the Mortality Information System (SIM) and the Notification Disease Information System (SINAN) for the period 2008 to 2015. The Human Development Units were characterized according to TB mortality and the variables determinants of health. Initially the cases of TB deaths were geocoded and gross mortality rates, Bayesian taxa were calculated and investigated for spatial autocorrelation and existence of clusters of risk by means of the spatial scanning technique and obtained relative spatial risks. In order to correlate spatial risk areas with mortality from TB, logistic regression was used as a risk variable: yes and no and after being evaluated using the ROC curve, a map of overlapping risk areas of social determinants correlated with clusters of risk for mortality. A total of 131 TB deaths were identified, 126 (96.2%) of which were geocoded and 05 (4%) of the deaths were TB and HIV and associated factors were Kaplan-Meier and Cox Regression. A total of 131 TB deaths were identified, of which 126 (96.2%) were geocoded and 05 (4.8%) were excluded due to incomplete addresses. For the first phase, the results were calculated at a gross average rate of 1.07 / 100,000 inhabitants. The deaths were distributed in a diffuse way, however, with greater concentration in the peripheral and southern regions of the municipality. It was detected a spatial cluster of risk in the southern region for mortality by TB and for variables of the social determinants of health and where the worst conditions were detected. The study confirmed the relationship between social determinants and risk areas for TB deaths when related to Dimension 1 extracted with (OR= 0,093; IC95% 0,34-0,25). The map of overlapping cluster-related risk clusters for TB mortality resulted in an OR= 5.95 IC95%=2.41-14.49 and ROC curve= 0.865 (CI95%= 0.796-0.934). In the second phase, when analyzing the early TB deaths, a median number of surviving days of 22 days was found, of which 88 (59.1%) died within 30 days after diagnosis and 107 (72.5%) after 60 days days (minimum: 1, maximum: 349, SD: 68.8 and average: 50 days). Among the 179 deaths analyzed, 105 (58.6%) deaths had a diagnosis of TB (ICD 15.0-19) and 74 (41.4%) had TB / HIV co-infection (ICD 20.0). The majority of the cases occurred in males, 138 (77.1%), the predominant white race (67%) and the mean age was 47 years (minimum: 20, maximum: 94, median: 44, DP: 14). The results corroborate the need for multiple improvements in the living conditions of the population, with a focus on the most vulnerable regions (areas of agglomerates of spatial risk) identified and specific policies to prevent alcohol use, in view of the identification of this factor associated with early deaths

Identification of novel Mycobacterium tuberculosis peptides as diagnostic reagents for tuberculosis among human immunodeficiency virus infected population / 中华传染病杂志

Objective To screen and validate the major histocompatibility complex class-Ⅰ(MHC-Ⅰ) restricted tuberculosis peptides as potential diagnostic reagents in tuberculosis interferon-gamma release assay (IGRA) used among human immunodeficiency (HIV)-infected population.Methods Candidate peptides were encoded by Mycobacterium tuberculosis (TB) RD (Region of difference).Computer software was used to predict and select CD8+ T cell epitopes restricted by MHC-Ⅰ molecules with high frequency and high affinity among HIV-infected people.Then peptides containing CD8+ T cell epitope were synthesized and screened in vitro.The sensitivity and specificity of IGRA using the above mixed peptides as stimulants were compared with those of IGRA using early secretory antigen target-6 (ESAT-6,molecular weight of 6 000) and culture filtrate protein-10 (CFP-10,molecular weight of 10 000) as stimulants among HIV-infected population.Results Eight overlapping peptides,including Rv0222176-191,Rv1980c122-138,Rv1985c105-120,Rv3425141-165,Rv3873133-151,Rv3873158-166,Rv387878-86,Rv3879c673-690,were obtained finally,which were able to stimulate the production of interferon-gamma from peripheral CD8+ T cells of tuberculosis patients,but not from peripheral blood mononuclear cells (PBMC) of healthy controls.Among the 25 patients with HIV/TB co-infection,the sensitivities of IGRA using the combination peptides (CP) and that using rESAT-6/CFP-10 (CE) were low (68％ vs 48％,x2 =2.052,P=0.152).However,the sensitivity increased to 92％ by using the combination of CP and CE,which was significantly higher than that using rESAT-6/CFP-10 alone (x2 =11.523,P ＜ 0.01),and the specificity was not affected.Conclusion These RD peptides with CD8+ T cell epitopes can increase the sensitivity of IGRA in detecting HIV/TB co-infection,which may improve the detection rate of tuberculosis in HIV infected population.

Tuberculosis in an HIV-infected Child in a Developing Country: A Case Report of Diagnosis Challenges.

Aims: To highlight the challenges and the diagnostic dilemmas in resource restricted settings to diagnose and treat Tuberculosis (TB), especially when it co-exists with Human immunodeficiency virus (HIV) infection. Presentation of Case: A 7-year-old HIV-infected male child admitted to our hospital with clinical features suggestive of Tuberculosis - non-productive cough of 6 months, associated excessive sweating and weight loss despite a good appetite. He did not receive Bacillus Calmette-Guerin (BCG) vaccine and no history of contact with Tuberculosis patient. He was wasted, small for age and, dyspnoeic, with features of consolidation in both lungs. All investigations initially carried out, including chest x-ray examination failed to confirm the diagnosis of TB. However, twenty-three (23) weeks after admission and commencement of antiretroviral drugs, was a radiologic diagnosis of TB made from a repeat chest x-ray examination. He subsequently commenced on anti-TB drugs with remarkable improvement, gaining 4Kg within two months. Discussion: Diagnosing Tuberculosis in developing countries can be very challenging, especially when there is a co-infection with HIV. The use of appropriate radiological, immunological and bacteriological tests and a good clinical acumen often defy the ability to make a timely diagnosis and institute appropriate treatment. These delays may eventually lead to increase morbidity and mortality. In this reported case of co-infections, it took twenty-three (23) weeks to establish a diagnosis of TB in the HIV-infected child. Provision of inexpensive, sensitive, specific, rapid point-of-care diagnostic tests for tuberculosis will reduce diagnosis delay and facilitate prompt and accurate treatment. Conclusion: Delay diagnosis and treatment of TB still occur in resource-poor countries, especially when it coexists with HIV infection. With the advent of new tests, such as GeneXpert MTB/RIF assay, the diagnosis of TB in HIV patients would be rapid and precise. Although this premise on its availability and maintenance in various clinics or hospitals where TB cases are managed.

Os significados da comorbidade para os pacientes vivendo com TB/HIV: repercussões no tratamento / The meanings of comorbidity for patients living with TB / HIV: implications in the treatment

O objetivo é compreender o processo de construção dos significados atribuídos pelos pacientes em relação à vivência da comorbidade tuberculose e HIV (TB/HIV), e sua repercussão nos respectivos tratamentos. Diante da complexidade do objeto, optou-se em estudá-lo à luz do referencial teórico do construcionismo social. O estudo qualitativo envolveu a realização de entrevista semiestruturada com dez pacientes com TB/HIV, acompanhados em um hospital na cidade do Rio de Janeiro. Os dados coletados foram submetidos à técnica de análise de conteúdo temático, organizados em cinco eixos: a) paciente e suas doenças; b) apoio; c) significados do tratamento; d) relação com o serviço de saúde; e e) estigma, preconceito e discriminação. Os resultados sinalizam que a vivência das duas condições e seus respectivos tratamentos é uma experiência difícil, trazendo sofrimento acentuado à vida dos pacientes. A TB acirra a dor do viver com HIV/Aids. O estigma da TB é reforçado pelo estigma da Aids, aumentando a vivência de medo associado ao preconceito. À família, à religião e ao serviço de saúde é atribuído papel fundamental, como lugar seguro e de preservação da identidade. Apesar do sofrimento físico, psicológico e moral e das dificuldades com ambos os tratamentos, é possível fazer conciliações no cotidiano.

This article aims to understand the construction process of meanings given by patients in relation to the experience of comorbidity tuberculosis and HIV (TB / HIV), and its impact on their treatments. Given the complexity of the subject, it was decided to study it in the light of the theoretical framework of social constructionism. The qualitative study involved the use of semi-structured interviews with ten patients with TB / HIV being treated at a hospital in the city of Rio de Janeiro. Data were examined with content analysis technique, organized into five areas: a) patient and their disease; b) support; c) treatment meanings; d) relationship with the health service; and e) stigma, prejudice and discrimination. The results indicate that the experience of the two conditions and their treatment is a difficult experience, bringing marked distress to patients' lives. TB intensifies the pain of living with HIV / AIDS. The stigma of TB is reinforced by the stigma of AIDS, increasing the fear of living associated with prejudice. To the family, religion and health services are entrusted key role as a safe place and identity preservation. Despite the physical, psychological and moral suffering and difficulties with both treatments, it is possible to make compromises in everyday life.

Treatment outcome of human immunodeficiency virus and tuberculosis co-infected patients in public hospitals of eastern and southern zone of Tigray region, Ethiopia

Background: Tuberculosis is a leading cause of death among people living with human immunodeficiency virus. In sub-Saharan Africa, tuberculosis accounts for more than 78% of all deaths among people with human immunodeficiency virus. Objectives: To assess tuberculosis treatment outcome and the associated factors in adult tuberculosis/human immunodeficiency virus co-infected patients in four public hospitals of eastern and southern zone of Tigray region, Ethiopia. Methodology: Institution based cross-sectional study design was used to examine secondary data from tuberculosis/human immunodeficiency virus co-infected patients attending four public hospitals of eastern and southern zone of Tigray, from January 2009 to August 2011. Systematic random sampling technique was used to select individual patient cards from the respective hospitals. Univariate analysis and multivariate logistic regression modeling was used to assess the impact of each variable in predicting treatment outcome. Results: Out of 342 patients included, 199 (58.2%) patients completed treatment, 43 (12.6%) patients were cured, 88 (25.7%) died, 7 (2%) defaulted, and 5 (1.5%) patients failed treatment. Treatment success rate was around 71%. In the multivariate logistic regression analysis the factors that were strongly associated with unfavorable tuberculosis treatment outcomes were WHO stage IV (AOR = 3.2, CI = 1.58-6.82, p-value = 0.001), age greater than 45 years (AOR = 6.08, CI = 2.28-16.23) and baseline CD4 count less than 200 cells/L (AOR = 6.19, CI = 2.28-16.89, p-value = 0.001). Conclusion: The rate of treatment success in this study was lower than the rate newly recommended by WHO. Therefore, efforts should be undertaken to improve treatment success rates of both diseases. .

Implementation of the Revised Guideline on TB/HIV Collaborative Activities in Lagos, Nigeria.

Background: The National Tuberculosis and Leprosy control programme commenced the implementation of the revised national tuberculosis/human immunodeficiency virus (TB/HIV) guideline in line with the recommendations from the World Health Organization in January 2013. This study evaluated the effect of the revised guideline on the implementation of TB/HIV collaborative activities geared towards reducing the burden of HIV in TB patients in Lagos, Nigeria. Methods: Retrospective review of presumptive and TB cases managed in TB treatment centers of the Lagos State TB and Leprosy control programme between January 1st to December 31st 2012 (pre implementation period) and January 1st to December 31st 2013 (post implementation period). Analysis was done using Statistical Package for Social Sciences (SPSS) version 19. Results: Of the 19,533 presumptive TB cases registered during the pre implementation period 17,530 (89.7%) were offered HIV counseling and testing (HCT) out of which 15,247 (87%) accepted to be tested and 20.9% of those tested for HIV were positive. However in the post implementation period, of the 22,721 presumptive TB registered cases, 20397 (89.8%) were offered HCT and 19,264 (94.4%) accepted to be tested. Of those that were tested, 4430 (23%) were HIV positive. The proportion of TB/HIV co-infected patients enrolled on co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART) during the pre and post implementation period were 76.6% vs 88.2% and 39.1% vs 49.8% respectively at p<.05. Conclusion: There was increase in the uptake of HIV testing, ART and CPT post implementation of the guideline. Sustaining the gains of policy implementation is of utmost importance.

Health System Barriers and Facilitators Influencing TB/HIV Integration in Ghana.

Introduction: A quarter of all TB cases in Ghana were HIV-positive at the end of 2012. The integration of TB and HIV services is anticipated to improve patient access to comprehensive care. Key health system components for successful integration are leadership and governance, health information systems, health financing, human resources for health, essential medical products and technologies, and service delivery This paper explores the health system barriers and facilitators influencing TB/HIV integration in Ghana. Study design: An interpretivist qualitative approach was employed and semi-structured interviews were used to generate data. Place and Duration: The study was conducted in the Eastern Region of Ghana between May and July 2009. Methodology: Three urban district hospitals with three different service delivery models with increasing levels of integration were purposively selected as study sites. Semi-structured interviews were conducted with purposively sampled TB/HIV patients, providers and managers. The audio recorded interviews were transcribed and thematically analysed using a-priori and emergent codes. Results: Twenty nine participants made up of 18 HIV-positive TB patients, eight providers and three managers participated in the study. Barriers included inadequate capacity, poorly motivated staff, different financial and health information systems, irregular and misapplied funds as well as differences in access to services. Facilitators included political will, direct supervision, regular supply of drugs, and privacy and confidentiality. Conclusion: The impact of facilitators needs to be enhanced to address related barriers. Standardisation of norms and values, as well as new staff training methods should be used to achieve staff behavioural changes towards integration.

HIV positivity in TB suspects - An observational, nonrandomized study.

Aims: The present study was carried out to determine the prevalence of TB, HIV, and TB- HIV co-infection in 618 patients who attended the health institute for TB diagnosis and treatment at a rural tertiary care hospital in Punjab. Methods: Pulmonary T.B was diagnosed by sputum smear microscopy, culture and extra-pulmonary TB was diagnosed by X-ray, CT and other methods.HIV diagnosis was made by testing the sera by 3E/R/S (ELISA/RAPID/SIMPLE) tests as per NACO guidelines. Results: Of the total 618 patients, 74(12%) were patients of pulmonary TB, out of whom 72 were diagnosed by Ziehl Neelsen (ZN) staining and two were diagnosed by culture as the ZN stained smear was negative, 169(27.3%) were cases of extra-pulmonary TB. Three out of 618 were HIV positive. 1.23% were TB- HIV co-infected. Conclusion: The risk of developing TB increases in patients with HIV. So, HIV and TB programmes should be collaborated together and should be closely integrated with medical care to curb the spread of these deadly diseases.

TB/HIV coordination through public private partnership: Lessons from the field.

Background: Co-infection with tuberculosis adversely affects the quality of life of HIV infected individuals and additionally, HIV testing among TB patients gives an opportunity for prevention and treatment of HIV infection. TB-HIV coordination activities are therefore a good public health intervention. Methods: It was a three-year Public Private Partnership Project, implemented in four districts of Maharashtra, to improve access to public health facilities through community awareness and motivating referrals. Outreach workers were engaged to motivate patients attending Integrated Counselling and Testing Centres (ICTCs) and Designated Microscopy Centres (DMCs) for cross referrals and adherence to services. Community leaders and private health providers were sensitized to issues around TB and HIV/AIDS. Observations: 357 outreach workers referred 17,200 individuals for HIV testing and 32,549 TB suspects were referred for testing. An average of 18% TB cases (13% to 26%) and 7% (4% to 13%) HIV infected cases were identified. Involvement of PLHA and cured TB patients can better motivate symptomatics to avail of diagnostic services. Erratic funding affects smooth implementation of programmes. Conclusion: Public Private Partnerships improve access to care. Constant dialogue between all stake holders is essential for successful implementation of such partnerships.

Tuberculose, HIV e coinfecção por TB/HIV no Sistema Prisional de Itirapina, São Paulo, Brasil / Tuberculosis, HIV and TB/HIV co-infection in the Prison System of Itirapina, São Paulo, Brazil

As prevalências do HIV, da tuberculose (TB) e da coinfecção TB/HIV foram avaliadas no Sistema Prisional de Itirapina/SP (Penitenciárias I e II). Foi efetuado estudo retrospectivo dos registros dos exames realizados no IAL-Rio Claro no período de janeiro/2003 a dezembro/2010. A baciloscopia/cultura para TB foi realizada em 24,3 % (1.375 amostras) da PI e em 25, 9 % (3.332 amostras) da PII, e a sorologia para HIV, em 1.810 amostras da PI (32,0 %) e em 2.634 (20,4 %) da PII. Foram detectadas 157 culturas positivas para micobactérias (3,3 %), 177 amostras soropositivas para HIV (4,0 %), e 16 positivas para TB/HIV (11,5 %). A prevalência de TB foi de 2,8 % e 3,6 % (p=0,160), de HIV foi de 2,1 % e 5,3 %(p<0,001), respectivamente, para PI e PII; e a de coinfecção TB/HIV foi 0,4 % (p=0,744) em PI e PII. A soroprevalência de HIV nos indivíduos com TB foi de 13,2 % em PI e 9,2 % (p=0,487) em PII; a prevalência maior em PII sugere que o comportamento da doença difere com a característica populacional. Elevada prevalência de TB, HIV e coinfecção TB/HIV mostra a importância do diagnóstico destas infecções em todos os indivíduos no momento da admissão para definir as medidas de prevenção e de tratamentos dos internos e seus contatos.

HIV, tuberculosis (TB) and TB/HIV co-infection prevalences were assessed in prisons PI and PII inItirapina, SP, Brazil. This retrospective study was performed by consulting the records of diagnosticassays carried out at the Instituto Adolfo Lutz (IAL) Rio Claro Laboratory from January 2003 toDecember 2010. Culture for TB was performed on 24.3 % (1,375 samples) of PI and 25.8 % (3,332samples) of PII, and HIV serology in 32.0 % (1,810 samples) of PI and 20.4 % (2,634 samples) ofPII. There were 177 (4.0 %) HIV positive samples, 157 (3.3 %) positive culture for mycobacteria,and 16 (11.5 %) for TB/HIV. The prevalences of TB were 2.8 % and 3.6 % (p=0.160) for PI and PIIrespectively; of HIV, 2.1 % and 5.3 % (p<0.001) for PI and PII; and of TB/HIV co-infection, 0.4 %(p=0.744) for both PI and PII. Among TB patients, HIV prevalence was 13.2 % in PI and 9.2 %(p=0.487) in PII. Higher HIV prevalence in PII suggests that it depends on the population characteristics.The high prevalence rates of TB, HIV and TB/HIV show that it is crucial to perform the diagnostic testingin all of imprisoned individuals at admission to define the disease treatment and prevention measuresamong inmates and their contacts.

Clinical Profile of pulmonary tuberculosis in patients with HIV infection.

Background: Tuberculosis is the commonest opportunistic infection and commonest cause of death in HIV/AIDS patients in India. Objective: To study the clinical, radiological and immunological profile of pulmonary tuberculosis in HIV infected patients. Methods: We conducted a retrospective study of 60 patients of pulmonary tuberculosis in patients with Human immunodeficiency virus positive. The diagnosis of tuberculosis was based on clinical evaluation, bacteriological examination including sputum smear and culture, tuberculin skin test and chest radiograph. CD4+ T cell counts were done on all patients. Results: Commonest risk factor for HIV transmission was sexual exposure in 47 cases (78%).35 cases (58.33%) had CD4+ T cell count <200/mm3, 25 cases (41.67%) had CD4+ T cell >200. constitutional symptoms (91.66%)like weight loss, anorexia, fatigue, night sweats are more common than classical symptoms of pulmonary TB like chest pain (66.66%) ,cough with/without expectoration (58.33%), dyspnoea (61.66%), fever (75%) and haemoptysis (8.33%). Most common opportunistic infection was oral/esophageal candidiasis (22%).35% of pstients had typical pattern and 65% had atypical pattern of pulmonary TB on chest radiograph. 80% of patients with CD4+ T cell count <200/mm3 had atypical pattern. In pulmonary tuberculosis sputum smear for AFB was positive in 20% cases & negative in 80% cases. Majority of the patients with positive sputum smear had CD4+T cell count >200/mm3. MDR-TB was documented in 9 (12%) of patients. 4 cases have CD4+ count <200and 5 cases have CD4+count >200. total mortality was 10% among 60 patients. Conclusion: Tuberculosis infection in patients with HIV is more common in second & third decade of life more common in males. Atypical features are more common than typical features in HIV-TB patients. Negative/anergic TST is more common in patients of HIV-TB co infection due to compromised CMI. Disseminated and multifocal lesions were more common in severe degree of immune compromise (CD4+ <200), whereas cavitory lesion and unifocal opacities were relatively more common in patients having CD4+ >200. Sputum AFB negative pulmonary TB is more if CD4 <200

Perfil dos casos novos de tuberculose notificados em Ribeirão Preto (SP) no período de 2000 a 2006 / Profile of new cases of tuberculosis in Ribeirão Preto, São Paulo State, in the period of 2000 to 2006

A Organização Mundial de Saúde estima que um terço da população mundial encontra-se infectada pelo Mycobacterium tuberculosis, sendo que 8-9 milhões de pessoas desenvolvem a doença e, anualmente, 2 milhões vão a óbito por tuberculose, principalmente em países e regiões com condições socioeconômicas precárias. Este estudo descreve o perfil dos casos novos de tuberculose notificados no município de Ribeirão Preto (SP) no período de 2000 a 2006. Utilizou-se um desenho descritivo do tipo coorte. Para a coleta dos dados, foi utilizado o banco de dados Epi-Tb. A forma clínica predominante foi a pulmonar. Verificou-se que 71,7 por cento dos doentes eram do sexo masculino e adultos jovens (20-39 anos). Em relação ao tipo de supervisão, observou-se aumento gradativo da forma supervisionada ao longo do período considerado, exceto no ano de 2003. A coinfecção Tb/HIV mostrou-se superior a 25 por cento, sendo que 12,9 por cento dos doentes não realizaram o teste anti-HIV. Quanto ao resultado de tratamento, a cura variou de 62,7 por cento a 76,7 por cento, a média do abandono foi de 4,3 por cento e óbito por tuberculose foi de 3,9 por cento. Os resultados apresentados contribuem para o conhecimento da situação epidemiológica da tuberculose ao longo dos anos, fornecendo subsídios à tomada de decisões relacionadas principalmente às ações de prevenção e controle da doença no município.

The World Health Organization estimates that one third of the world population is infected by the Mycobacterium tuberculosis, while 8-9 million of people develop the disease and 2 million die each year due to tuberculosis, especially in countries and regions with precarious socioeconomic conditions. This study describes the profile of new cases of Tuberculosis notified in Ribeirão Preto, São Paulo State, in the period between 2000 and 2006. A cohort descriptive design was used. The database Epi-Tb was used for the data collection. The clinical form predominant was pulmonary. It was verified that 71.7 percent of patients were male and young adults (20-39 years). Regarding the type of supervision, it was observed that the supervised form presented a progressive increase along the period considered, with exception of 2003. The Tb/HIV co-infection was superior to 25 percent, while 12.9 percent of the patients performed the test. Regarding the treatment result, cure varied from 62.7 percent to 76.7 percent, the abandonment mean was 4.3 percent and death by tuberculosis was 3.9 percent. The results presented contribute for the knowledge of the tuberculosis epidemiological situation along the years studied, providing support to decision making related to prevention actions and control of the disease in the municipality.

Presentation of tuberculosis in TB-HIV co-infection patients and the treatment outcome with directly observed short course therapy

Objective:To investigate different presentations of tuberculosis in HIV positive patients and their treatment outcome with directly observed short course therapy (DOTS). Methods: All patients having tuberculosis-HIV (TB-HIV) co-infection were taken. Different manifestations of tuberculosis in HIV positive patients were analyzed. Outcome of the treatment was observed in 14 patients. The rest of the patients were either transferred to other districts or still continuing their DOTS therapy according to the revised national tuberculosis control programme (RNTCP). Results:A total of 901 patients were diagnosed as tuberculosis. Out of these, 227 had positive pulmonary tuberculosis smear, 212 had negative smear and 462 had extra pulmonary tuberculosis. A total of 65 patients suffered from TB-HIV co-infection (7%). Result showed that the incidence of TB-HIV coinfection was the highest in productive age group of 16-45 years old (75%). Treatment completion rate was only 57%and the rate was higher in extra pulmonary tuberculosis patients (83%). Out of 4 sputum positive cases, 3 were declared cured (75%). Conclusions:TB-HIV co-infection in wardha (Cental India) is around 7%. Pattern of tuberculosis in HIV positive patient is the same as in HIV negative patient. Pattern of extra-pulmonary tuberculosis in HIV positive patients is mainly in form of tubercular lymphadenitis and pleural effusion. DOTS is the best modality of treatment of tuberculosis.

Implementation of TB/HIV collaboration program in Phnom Penh, Cambodia / 国際保健医療

<B>Background</B><br>The national tuberculosis (TB) control program established Phnom Penh as a pilot area for TB and human immunodeficiency virus (HIV) infection collaborative activities because of the high prevalence of HIV among patients with TB.<br><B>Process</B><br>In 2005, we provided transportation fees so that patients could travel to an operational district referral hospital for HIV counseling and testing by dispatched counselors. However, only around 10.3 patients with TB (range 0-21) per month in all 4 operational districts made use of this service. In 2006, we modified the program by providing HIV counseling and testing by four trained TB/HIV coordinators in TB wards. Thereafter, in-depth, individual, semi-structured interviews were conducted with the TB staff (not the coordinators) of 18 health facilities from April through November 2006 to identify problems in the current TB/HIV collaborative activities in Phnom Penh and to investigate ways for further improving the program.<br><B>Results</B><br>TB staff members encouraged their patients to undergo an HIV test under directly observed treatment, short course. Some TB staff lacked confidence to discuss HIV issues because they lacked sufficient HIV/ acquired immunodeficiency disease syndrome (AIDS) knowledge. Furthermore, there was no formal referral structure between TB and HIV services or sharing of information on the treatment of patients co-infected with TB/HIV with the antiretroviral treatment clinic.<br><B>Conclusions</B><br>We started the program to enable TB patients to receive HIV counseling and testing at the same venue as they received TB treatment. However, problems such as low confidence among TB staff in discussing HIV/AIDS and weak collaboration between TB and HIV services were identified. We found that training of TB staff, development of Information, Education and Communication (IEC) materials, regular meetings among stakeholders, and encouragement for the TB/HIV coordinators to supervise all TB/HIV activities in their operational districts were needed to improve the program.

Evaluation of effectiveness of a project for treating TB/HIV co-infection(phase 1)supported by Global Funds in Wolong district / 中国艾滋病性病

Objective To evaluate the effectiveness of a project for treating TB/HIV co-infection(phase 1,2007-2008)supported by Global Fund in Wolong district.Method Data on project implementation in 2007-2008 were collected and analyzed.Results A total of 916 TB patients were diagnosed in 2007-2008,of whom 847 cases were detected for HIV antibody,with a detection rate of 92.47%.A total of 368 people living with HIV/AIDS were identified by screening 1790 persons/times,with a screening rate of 94.36%.Among them 55 cases of active tuberculosis were co-infected with HIV,of whom 3 were smear positive.After aniti-TB chemotherapy marked symptomatic improvement was witnessed in 37 cases;the curative rate for new smear positive cases reached 66.7% and the remission rate was 70.0%.Conclusion Satisfactory results were achieved in preventing and treating TB/HIV co-infection in Wologn district,and the experience gained in implementing the phase 1 project will provide useful information for implementing the project for the next phases.