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HIV sero-prevalence among tuberculosis patients in Kenya
J Van Gorkom1, D Kibuga, S Adallah
1Royal Netherlands Tuberculosis Association, The Hague, Netherlands.
Objective:
To determine HIV seroprevalence among tuberculosis patients and the burden of HIV attributable tuberculosis among notified patients in Kenya.
Design:
A cross-sectional anonymous unlinked HIV seroprevalence survey.
Setting:
Tuberculosis diagnostic clinics of the National Leprosy Tuberculosis Programme in 19 districts.
Subjects:
One thousand nine hundred and fifty-two newly notified tuberculosis patients.
Interventions:
Selection and registration of eligible subjects followed by obtaining 5 ml of full blood for haemoglobin testing and separation of serum for HIV testing by ELISA.
Main Outcome Measures:
HIV seroprevalence per district and burden of HIV attributable tuberculosis among tuberculosis patients.
Results:
A total of 1,952 eligible patients were enrolled. The weighted seroprevalence in the sample was 40.7% (range 11.8-79.6% per district). The seroprevalence was significantly higher among females and patients with sputum-smear negative tuberculosis. Chronic diarrhoea, female sex, oral thrush and a negative sputum were independent risk factors for HIV infection. The Odds ratio for HIV infection in female tuberculosis patients aged 15-44 years, was 5.6 (95% CI 4.5-6.9) compared with ante-natal clinic attenders. The population attributable risk was 0.22 in 1994.
Conclusion:
The HIV epidemic has had a profound impact on the tuberculosis epidemic in Kenya and explains about 41% of the 94.5% increase of registered patients in the period 1990-1994 and 20% of all registered patients in 1994. Repetition of the survey with inclusion of a more representative control group from the general population may provide a more accurate estimation of the burden of HIV attributable tuberculosis.