1. The tuberculosis challenge in a rural South African HIV programme
- Author
-
Marie-Louise Newell, Richard J Lessells, Portia Mutevedzi, Catherine F Houlihan, Graham S Cooke, and Frank Tanser
- Subjects
Adult ,Male ,Rural Population ,Tuberculosis ,Adolescent ,Population ,Developing country ,HIV Infections ,Disease cluster ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,South Africa ,Young Adult ,0302 clinical medicine ,Sex Factors ,Risk Factors ,Health care ,Prevalence ,Medicine ,Humans ,lcsh:RC109-216 ,030212 general & internal medicine ,education ,0303 health sciences ,education.field_of_study ,AIDS-Related Opportunistic Infections ,030306 microbiology ,business.industry ,Incidence (epidemiology) ,Incidence ,Viral Load ,medicine.disease ,3. Good health ,CD4 Lymphocyte Count ,Infectious Diseases ,Immunology ,Female ,Rural area ,business ,Viral load ,Demography ,Research Article - Abstract
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 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.
- Published
- 2010