Integration of HIV testing in tuberculosis drug resistance surveillance in Kazakhstan and Kenya.

In Kenya and Kazakhstan, integration of human immunodeficiency virus (HIV) testing results into the routine surveillance of multidrug-resistant tuberculosis (MDR-TB) proved feasible and useful. The integration process improved overall data quality and data validation capacity, and integrated data are a useful addition to routine cohort and treatment outcome data. Besides their importance for individual patient care, they provide trends on the association of MDR-TB and HIV in the routine programme setting. They also form a useful epidemiological basis for more specific studies, such as on nosocomial outbreaks. Whether the system itself is sensitive enough to monitor possible outbreaks needs further investigation.

Tuberculosis transmission in Kenya: results of the third National Tuberculin Survey.

SETTING: Kenya, a country with a high burden of tuberculosis (TB) and human immunodeficiency virus (HIV) infection. OBJECTIVES: To assess the prevalence of TB infection, bacille Calmette-Guérin (BCG) coverage and the annual risk of tuberculosis infection (ARTI), and to compare estimates with previous findings. METHODS: A sample of primary school children aged 6-14 years from the same study districts sampled in previous surveys were tuberculin skin tested using the Mantoux method from September 2004 to July 2007. The prevalence of TB infection was estimated by the mirror method, with the mode at 17 mm. RESULTS: Of the 94 771 registered children, 76 676 (80.9%) completed the survey investigations, 12 107 (15.8%) of whom had no BCG scar. The prevalence of TB infection was estimated at 10.2%, with a corresponding ARTI of 1.1%. The ARTI obtained from the current survey is comparable to that of the 1994-1996 survey and higher than that of the 1986-1990 survey. The BCG coverage was comparable with the 1994-1996 survey and higher than in the 1986-1990 survey. CONCLUSION: TB transmission in Kenya has remained the same over the last decade, which suggests that activities undertaken by the TB control programme have been sufficient to hold TB transmission steady, but insufficient to reduce it.

Revising the tuberculosis recording and reporting information system.

OBJECTIVE: The tuberculosis recording and reporting information system (TB R&R), one of the five pillars of the DOTS strategy, has undergone a revision to comply with the new elements of the Stop TB Strategy and to ensure standardisation of essential TB information. DESIGN: An expert group on TB R&R, including the main technical partners, held a series of consultations with the Stop TB Working Groups and countries. Draft revised forms were field tested by countries with the participation of technical partners. A survey was conducted by the World Health Organization (WHO) in 105 countries. RESULT: The main changes in the TB R&R are the inclusion of TB-HIV activities (the leading reason for change at the country level), smear examinations and culture for settings performing this test routinely and the management of patient drug kits. The revised forms help monitor contributions from all care providers and community workers. The package of forms is presented in three sets: 1) essential data, 2) setting with routine culture and 3) additional data. CONCLUSION: The revised R&R forms were endorsed by the WHO, the KNCV Tuberculosis Foundation, the International Union Against Tuberculosis and Lung Disease and the US Centers for Disease Control and Prevention in 2007. They are now available in English, French and Spanish, and are adopted in most countries.

National scale-up of HIV testing and provision of HIV care to tuberculosis patients in Kenya.

SETTING: Kenya, one of the 22 tuberculosis (TB) high-burden countries, whose TB burden is fuelled by the human immunodeficiency virus (HIV). OBJECTIVE: To monitor and evaluate the implementation of HIV testing and provision of HIV care to TB patients in Kenya through the establishment of a routine TB-HIV integrated surveillance system. DESIGN: A descriptive report of the status of implementation of HIV testing and provision of HIV interventions to TB patients one year after the introduction of the revised TB case recording and reporting system. RESULTS: From July 2005 to June 2006, 88% of 112835 TB patients were reported to the National Leprosy and TB Control Programme, 98773 (87.9%) of whom were reported using a revised recording and reporting system that included TB-HIV indicators. HIV testing of TB patients increased from 31.5% at the beginning of this period to 59% at the end. Of the 46428 patients tested for HIV, 25558 (55%) were found to be HIV-positive, 85% of whom were provided with cotrimoxazole preventive treatment and 28% with antiretroviral treatment. CONCLUSION: A country-wide integrated TB-HIV surveillance system in TB patients can be implemented and provides essential data to monitor and evaluate TB-HIV related interventions.

Urgent need for a new approach to the diagnosis of tuberculosis in developing countries in the decade of AIDS.

In many developing countries with a high prevalence of both tuberculosis and HIV infection a dramatic increase of tuberculosis is seen. Our present ability to diagnose tuberculosis in developing countries has its limitations. This review article discusses old and new approaches to the diagnosis of tuberculosis and their value for developing countries.

Mortality and geographical distribution of AIDS patients in Mangochi: an indication of the impact on Mangochi Hospital

In an attempt to determine a possible impact of the AIDS epidemic on Mangochi Hospital; basic information such as drug use; admission days and date and place of death of 971 patients presenting at Mangochi Hospital between 1986-1990 was prospectively studied. The study shows that; despite the rural characteristics of the district; AIDS/HIV infection is strongly related in urban and rural settings to a high economic activity

Aids in Mangochi District: Clinical Presentations

This prospective study describes the clinical features and some epidemiological characteristics of 971 AIDS patients seen in Mangochi district Hospital between 1986 and June 1990. The incidence of new AIDS cases doubled yearly resulting in 120 new cases per 100;000 population in 1990

Meningitis in children at Mangochi District Hospital

Although a lot of improvement has been achieved in diagnosis and treatment of acute meningitis; a remarkable number of children die or remain handicapped. This article reviews the presentation of meningitis in children at Mangochi District Hospital