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Interest in epidemiology of tuberculosis in Sub-Sahara Africa has been activated by its reemergence in the mid-1990s because HIV and poverty have created a lethal combination that propagates TB transmission. Three provinces of Kenya that collectively contribute to about 56% of TB cases notified in Kenya were included in the study. Data for smear positive TB and TB HIV was extracted from existing database between 2003 and 2009. Data was analyzed to produce trends for each of the provinces, and descriptive statistics were calculated. To deduce existence of differences in gender, provinces, and years, analysis of variance was carried out with p values and confidence intervals generated. There were more males (56%) than females affected by TB, but more females with dual infection. Females have a bimodal peak in age groups 15-24 and 25-34, while males have one peak age group at 15-24. The rate of decline for males was higher than for females. Significant differences were found in gender (P = 0.001), year (P = 0.001), and rate of HIV positivity across the provinces (P = 0.001). Declining trend in cases is attributed to effects of integrating TB and HIV services and therefore programs need to address barriers to integrate care. [ABSTRACT FROM AUTHOR]

The article discusses a report on HIV data from Kenya's tuberculosis (TB) surveillance system from 2006 to 2009. The Kenya Division of Leprosy, Tuberculosis and Lung Disease (DLTLD) added HIV testing and treatment to its TB surveillance program at the recommendation of the World Health Organization (WHO). HIV testing among patients with TB increased during this period, while HIV infection among TB patients decreased. It was found that HIV-infected TB patients receiving antiretroviral therapy (ART) also increased.

The article focuses on a report on developments in HIV-testing and treatment among patients with tuberculosis (TB) in Kenya during the period of 2006 to 2009. The report showed that HIV testing among TB patients increased from 60% in 2006 to 88% in 2009, while the prevalence of HIV infection among the TB patients tested declined from 52% to 44%. Recommendations made by the TB/HIV Coordinating Committee established by the Kenya Ministry of Health have included the use of the existing national TB program infrastructure to increase HIV counseling and testing services.

Summary Using data of human immunodeficiency virus-positive patients with tuberculosis from three primary care clinics in Kibera slums, Nairobi, Kenya, we report on the proportion that started antiretroviral treatment (ART) and attrition (deaths, lost to follow-up and stopped treatment) before and while on ART. Of 427 ART eligible patients, enrolled between January 2004 and December 2008, 70% started ART, 19% were lost to attrition and 11% had not initiated ART. Of those who started ART, 14% were lost to attrition, making a cumulative pre-ART and ART attrition of 33%. ART uptake among patients with TB was relatively good, but programme attrition was high and needs urgent addressing. [ABSTRACT FROM AUTHOR]

Objective To develop new methods for estimating the sputum smear-positive tuberculosis case detection rate (CDR) in a country where infection with HIV is prevalent. Methods We estimated the smear-positive tuberculosis CDR in HIV-negative and HIV-positive adults, and in all adults in Kenya. Data on time trends in tuberculosis case notification rates and on HIV infection prevalence in adults and in tuberculosis patients were used, along with data on tuberculosis control programme performance. Findings In 2006, the estimated smear-positive tuberculosis CDR in HIV-negative adults was 79% (95% confidence interval, CI: 64--94) and in HIV-positive adults, 57% (95% CI: 26--88), giving a weighted mean of 68% (95% CI: 49--87). The separate estimate for all smear-positive tuberculosis cases was 72% (95% CI: 53--91), giving an overall average for the three estimates of 70% (95% CI: 58--82). As the tuberculosis CDR in 1996 was 57% (95% CI: 47--67), the estimated increase by 2006 was 13 percentage points (95% CI: 6--20), or 23%. This increase was accompanied by a more than doubling of the resources devoted to tuberculosis control in Kenya, including facilities and staff. Conclusion Using three approaches to estimate the tuberculosis CDR in a country where HIV infection is prevalent, we showed that expansion of the tuberculosis control programme in Kenya led to an increase of 23% in the CDR between 1996 and 2006. While the methods developed here can be applied in other countries with a high prevalence of HIV infection, they rely on precise data on trends in such prevalence in the general population and among tuberculosis patients. Copyright © 2009 World Health Organization [ABSTRACT FROM AUTHOR]