Prevalence and predictors of HIV among Chinese tuberculosis patients by provider-initiated HIV testing and counselling (PITC): a multisite study in South Central of China.

BACKGROUND: Tuberculosis (TB) and HIV are two worldwide public health concerns. Co-infection of these two diseases has been considered to be a major obstacle for the global efforts in reaching the goals for the prevention of HIV and TB. METHOD: A comprehensive cross-sectional study was conducted to recruit TB patients in three provinces (Guangxi, Henan and Sichuan) of China between April 1 and September 30, 2010. RESULTS: A total of 1,032 consenting TB patients attended this survey during the study period. Among the participants, 3.30% were HIV positive; about one quarter had opportunistic infections. Nearly half of the participants were 50 years or older, the majority were male and about one third were from minority ethnic groups. After adjusting for site, gender and areas of residence (using the partial/selective Model 1), former commercial plasma donors (adjusted OR [aOR] = 33.71) and injecting drug users(aOR = 15.86) were found to have significantly higher risk of being HIV-positivity. In addition, having extramarital sexual relationship (aOR = 307.16), being engaged in commercial sex (aOR = 252.37), suffering from opportunistic infections in the past six months (aOR = 2.79), losing 10% or more of the body weight in the past six months (aOR = 5.90) and having abnormal chest X-ray findings (aOR = 20.40) were all significantly associated with HIV seropositivity (each p<0.05). CONCLUSIONS: HIV prevalence among TB patients was high in the study areas of China. To control the dual epidemic, intervention strategies targeting socio-demographic and behavioral factors associated with higher risk of TB-HIV co-infection are urgently called for.

[The long term (9-year) survival of multidrug-resistant tuberculosis patients compared to non-multidrug-resistant tuberculosis patients in Henan province].

OBJECTIVE: To investigate the long term survival of MDR-TB patients compared to non-MDR-TB in Henan province in 2010. METHODS: Participants were randomly selected in 2010 from a dataset generated by an anti-TB drug resistance surveillance survey conducted by the Tuberculosis Control Institute, Henan Centre for Disease Control and Prevention in 2001, supported by the World Health Organization. Information on patient's demographic profile and medical records was extracted by trained doctors and nurses at local anti-TB dispensaries. Interviews were carried out using questionnaires to collect information on the socioeconomic features and survival status. Bivariate and multivariate with logistic regression were performed for data analysis. RESULTS: The long term outcome of MDR-TB patients was much poorer when compared to non-MDR-TB patients. The case fatality was much higher among MDR-TB than non-MDR-TB patients (22.1% vs. 6.7%). The risk factors associated with the poorer outcome would include drug resistance status, disease relapse, hospitalization for treatment and long treatment period. Compared to non-MDR-TB, the survival time for MDR-TB was much shorter after having had the disease (6.7 years vs. 8.0 years). CONCLUSION: MDR-TB patients had poor long term outcomes. As most of the cured TB patients were under productive age in the society, the high case fatality rate of MDR-TB would impose big burden on the related family and communities. Findings from this study suggested that the TB control programs should involve more efforts be paid on MDR-TB control, in order to reduce the burden of the disease.

[A survey on the infection rate of tuberculosis among employees of the antituberculosis institutions in Henan province, China].

OBJECTIVE: To study the situation of tuberculosis (TB) infection among the employees of the anti-TB institutions in Henan. METHODS: Cross-sectional study was adopted the employees working in all municipal-level- anti-TB institutions and 40 anti-TB institutions at county-level selected randomly from 109 counties of the province were regarded as surveyed objects. Tuberculin skin test (TST) was used to test the infection with PPD. RESULTS: 2153 employees accepting the TST and the positive rate was 60.6%, of which the positive rate was 66.1% among healthcare workers. Among the employees and healthcare workers, the positive rates of TST adjusted by the stratum weights between municipal-level and county-level institutions were 57.3% and 62.8% respectively with Chi-square test the analysis of multivariate logistic vegression, both positive rate and strong positive rate among healthcare workers, the employees older than 30 years of age and working in municipal-level institutions were significantly higher than those among non-healthcare workers, the employees younger than 30 years old and working in county-level institutions, respectively. There were not significant differences of positive and strong positive rates between employees with and without BCG-history, or between male employees and female employees. CONCLUSION: Program on TB infection control in anti-TB institutions of Henan were weak and the employees especiolly healthcare workers had a high vocational exposure.

[Impact of anti-tuberculosis drug resistance on treatment outcome of pulmonary tuberculosis patients receiving directly observed treatment strategy in Henan Province, China].

OBJECTIVE: To study the impact of anti-tuberculosis drug resistance on treatment outcome of pulmonary tuberculosis (TB) patients receiving directly observed treatment strategy (DOTS) in Henan Province, China. METHODS: From Aug. 2001 to Jun. 2002, the second round surveillance of anti-TB drug resistance was carried out in cooperation with WHO in Henan Province, China. The proportion method was used for drug susceptibility test and all enrolled patients were administrated with DOTS. RESULTS: The treatment success rate of smear-positive patients was 85.5% (1,343/1,571), of which the treatment success rate of initial-treatment cases was 89.6% (1,159/1,293). The treatment success rates among 565 anti-TB drug resistant cases and 215 multi-drug-resistant-TB (MDR-TB) cases were 76.6% (433/565), (initial treatment cases: 86.8%, 341/393; re-treated cases: 53.5%, 92/172; being significantly different), 58.6% (126/215), (initial treatment cases: 75.4%, 83/110; re-treated cases: 41.0%, 43/105; being significantly different), respectively. For the cases being resistant to 2, 3 or 4 drugs, the treatment success rates in initial treatment cases were all higher than those in re-treatment cases. Multivariate analysis showed that re-treatment, resistance to 2 plus drugs or MDR were the significant risk factors for treatment failure, and that re-treatment, older age and MDR were the significant risk factors for TB death. CONCLUSION: The treatment outcome of initial treatment of smear-positive patients with DOTS in Henan was satisfying, but that of retreated patients, especially retreated patients of MDR was very poor. Re-treatment, older age, resistance to 2 anti-TB drugs or MDR were the risk factors for the poor outcome of treatment with DOTS.

[Epidemiological survey on bronchial asthma in Henan province].

OBJECTIVE: To survey asthma prevalence, correlation factors for prevention, treatment, and for policy decision of asthma control. METHODS: Done with TB epidemiological survey synchronously, sampling by stratified-cluster-random method. 43 points were selected and distributed in all 18 prefectures in Henan province. Sampling population was 75 134, and 65 033 (97.0%) were investigated actually. RESULTS: In this survey, 682 asthma patients were found. The total prevalence rate was 1.05%, the rate for children was 1.71%, and that for adult was 0.82%; the rates for male and female were 1.16%, 0.94% respectively. The ratio of male to female was 1.23:1. When asthmatic chronic bronchitis cases were regarded as asthma cases and included in total asthma cases, the overall prevalence rate of asthma would increase up to 1.73%, raised by 65%. The higher prevalence were in 0 approximately 3 years old age group (4.48%) and >/= 65 years old age group (1.43%), the lowest prevalence was in 15 approximately 24 years old age group (0.36%). For 90% of asthmatic children, the initiative age of asthma was before 7 years old, and for 1/3 adult patient, it was in childhood. The prevalence of asthma in rural area was higher than that of urban area. Cold air, common cold, stimulation of smoking and cooking, and room dust were the 4 main inducing factors. Seasonal attack of asthma accounted for 67.2%, and that in winter and spring was 65.4%. 60.6% of asthma cases showed history of allergic diseases including allergic rhinitis, dermatitis, and drug allergy; 34.3% asthma family history. CONCLUSIONS: The rate of prevalence and inducing factors of asthma in Henan province were gained in this survey. The results may basically reflect the present status and be provided for asthma control as reference. According to the prevalence, asthma cases would be up to 0.98 approximately 1.6 million in whole Henan province and more attention should be paid to this situation.