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Tuberculosis in HIV programmes in lower-income countries: practices and risk factors
Summary
Tuberculosis (TB) is common in HIV patients on antiretroviral treatment (ART). Isoniazid preventive treatment (IPT) significantly reduced TB risk but was underutilized in lower-income countries.
Area of Science:
- Global Health
- Infectious Diseases
- HIV/AIDS Research
Background:
- Tuberculosis (TB) is a significant opportunistic infection in individuals with human immunodeficiency virus (HIV) receiving antiretroviral treatment (ART).
- Understanding TB incidence and prevention strategies within ART programs in resource-limited settings is crucial for patient outcomes.
Purpose of the Study:
- To characterize TB-related practices in ART programs across lower-income countries.
- To identify key risk factors associated with TB development during the initial year of ART initiation.
Main Methods:
- A standardized electronic questionnaire assessed program characteristics across 15 ART sites in 12 countries.
- Patient data from 2003-2008 were analyzed using Poisson regression to calculate incidence rate ratios (IRRs).
Main Results:
- Diagnostic availability varied, with 86.7% offering Chest X-ray and 53.3% offering sputum culture.
- Isoniazid preventive treatment (IPT) was used in only 33.3% of programs but significantly reduced TB risk (IRR 0.24).
- Lower CD4 cell counts, female sex, and lack of IPT were identified as risk factors for TB.
Conclusions:
- Significant variability exists in TB diagnostic capabilities and treatment practices within ART programs globally.
- IPT demonstrates high efficacy in preventing TB among HIV-infected individuals but requires wider implementation.
- Enhanced strategies are necessary to mitigate the substantial burden of TB in co-infected populations within lower-income settings.
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