Title: The TB challenge in a rural South African HIV programme
Authors: Houlihan C, Mutevedzi P, Lessells R, Cooke G, Tanser F, Newell ML.
Journal: BMC Infect Dis,10:23 (2010)
Journal Impact Factor (I.F.): 2.83
Number of citations (Google Scholar): 16
Background: South Africa remains the country with the greatest burden of HIV-infected individuals and the
second highest estimated TB incidence per capita worldwide. Within South Africa, KwaZulu-Natal has one of the
highest rates of TB incidence and an emerging epidemic of drug-resistant tuberculosis.
Methods: Review of records of consecutive HIV-infected people initiated onto ART between 1st January 2005 and
31st March 2006. Patients were screened for TB at initiation and incident episodes recorded. CD4 counts, viral loads
and follow-up status were recorded; data was censored on 5th August 2008. Geographic cluster analysis was
performed using spatial scanning.
Results: 801 patients were initiated. TB prevalence was 25.3%, associated with lower CD4 (AHR 2.61 p = 0.01 for
CD4 <50 cells/?l) and prior TB (AHR 1.58 p = 0.02). Incidence was 6.89 per 100 person-years from 81 cases over
1175 person-years analysis time and was highest in the first 3 months after ART initiation; associated with male sex
and higher log HIV RNA. Prevalent and incident TB were significantly associated with mortality (OR 1.81 p = 0.01
and 2.02 p = 0.01 respectively). Incident TB was associated with a non-significant trend towards viral load >25
copies/ml (OR 1.75 p = 0.11). A low-risk cluster for incident TB was identified for patients living near the local
hospital in the geospatial analysis.
Conclusion: There is a large burden of TB in this population. Rate of incident TB stabilises at a rate higher than
that of the overall population. These data highlight the need for greater research on strategies for active case
finding in rural settings and the need to focus on strengthening primary health care.
Citation: Houlihan C, Mutevedzi P, Lessells R, Cooke G, Tanser F, Newell ML. The TB challenge in a rural South African HIV programme BMC Infect Dis,10:23 (2010).