Factors Associated with Prevalent Tuberculosis Among Patients Receiving Highly Active Antiretroviral Therapy in a Nigerian Tertiary Hospital

Background: Tuberculosis (TB) causes significant morbidity/mortality among human immunodeficiency virus­infected individuals in Africa. Reducing TB burden in the era of highly active antiretroviral therapy (HAART) is a public health priority.Aim: We determined the factors associated with prevalent TB among patients receiving HAART.Subjects and Methods: We conducted a cross­sectional study of adult patients who had received HAART for ≥12 weeks in a Nigerian tertiary hospital. Patients whose TB diagnosis predated HAART were excluded from the study. Pre­HAART data were collected from the clinic records, whereas post­HAART data were obtained through medical history, physical examination, and laboratinvestigations.StandardTBscreening/diagnostic algorithms as applicable in Nigeria were used. Logistic regression analysis was used to determine factors independently associated with prevalent TB.Results: about 65.8% (222/339) were women. The mean age was 41.1 (10.0) years and 23.6% (73/339) had past history of TB. The prevalence of active TB was 7.7% (26/339). Among these patients, 42.3% (11/26) had pulmonary TB, 34.6% (9/26) had disseminated TB, whereas 23.1% (6/26) had only extra­pulmonary disease. Only 45% (9/20) of patients with pulmonary involvement had positive sputum smear. Factors independently associated with prevalent TB were lower social class (adjusted odds ratio [aOR]: 31.7; 95% confidence interval [CI]: 1.1­1417.3), HAART non­adherence (aOR125.5; 95% CI: 9.6­1636.3), baseline CD4 <200cells/µl (aOR31.0; 95%CI: 1.6­590.6), previous TB (aOR13.8; 95% CI: 2.0­94.1), and current hemoglobin <10 g/dl (aOR10.3; 95% CI: 1.1­99.2).Conclusion: Factors associated with prevalent TB were a lower social class, HAART non­adherence, severe immunosuppression before HAART initiation, previous TB, and anemia post­HAART. TB case finding should be intensified in these high­risk groups

The Role of Pregnancy Intention in HIV Prevention in South Africa: a Proposed Model for Policy and Practice

Mother-to-child transmission is a continuing source of new HIV infections in South Africa. The paper posits that insight into the socio-cultural; behavioural; environmental and economic factors that sustain the HIV epidemic is as important as understanding the biological causes of the disease when planning and implementing interventions to prevent and reduce perinatal transmission. Furthermore; understanding the pregnancy intentions of individuals in areas of endemic HIV/AIDS is vital for providing the best care for individuals who are HIV-positive. This paper suggests a model for types of support and interventions that are relative to the intention of HIV-positive women or couples to become pregnant. Included among these are interventions for prevention of unwanted pregnancy; prevention of transmission of HIV; protection of the infant; and protection of the mother