TABLE OF CONTENTS

1. RETROSPECTIVE STUDY OF PREVALENCE OF PATIENTS TB/HIV CO-INFECTED AT LETLHAKANE PRIMARY HOSPITAL (BOTSWANA) IN 2012

2. TABLE OF CONTENTS • Introduction • General considerations • Methods and discussion about the prevalence of co-infected patient in Letlhakane Primary Hospital (2012) • Conclusion • references

3. INTRODUCTION • Since 2004, TB related deaths among people living with HIV have fallen to 28% in sub-Saharan Africa, WHO estimate that scaling up collaborative HIV and TB activities meant that an estimated 1.3million people avoided dying from AIDS-related causes from 2005-2011.

4. . • The human immunodeficiency virus (HIV) pandemic presents a massive challenge for global tuberculosis(TB) control. • Botswana like other sub-Saharan African countries experiences a huge burden of TB/HIV co-infection. • The dramatic increases in TB incidence over the past 2 decades is due to the increasing of prevalence of HIV, at present the country estimate 60-80% of TB patients co-infected with HIV. • Tuberculosis, one of the most opportunistic infection and leading of morbidity and mortality in HIV patients.

5. . • Botswana has one of the highest rate of HIV in the word. Data from the 2008 HIV/AIDS impact survey shows a prevalence of 17.6% among the general population and 40% prevalence of HIV among people aged 30-44years, the first case of HIV in Botswana was diagnosed in 1985 and by 2009 there were 331000 people HIV positive and 8700 annual HIV/AIDS related death.

6. GENERAL CONSIDERATIONS • Co-infection with TB and HIV markedly increases the mortality and morbidity of both diseases, and represents ongoing public heath crisis in Botswana. Patients with both infections are more likely to have extra pulmonary TB and so diagnosis of TB is often difficult, especially in advanced stage of HIV. HIV increases the rate of progression of TB infection to active diseases and increase the risk of TB recurrence.

7. . • People living with HIV have 10% annual risk of reactivating latent TB infection, compared to a 10% lifetime risk in HIV negative individuals, tuberculosis also increases HIV progression AIDS by decreasing CD4 counts and increases viral loads.

8. METHODS AND DISCUSSION ABOUT CO-INFECTION IN LETLHAKANE PRIMARY HOSPITAL • In Letlhakane Primary Hospital year 2012, for all the patients HIV positive on treatment or not with symptoms as followed were screened for TB/HIV co-infection : - Cough,fever,night sweats, weight lost, lymphadenopathy of any duration - In children also included : decreased playfullness,failure to gain weight and TB exposure in the house hold - All patients on ARV treatment with detectable viral load.

9. . • A positive response or finding to any one of these signs and symptoms requires father evaluations for TB by providing sputum samples(2) for smear microscopy (1) for culture and chest x-ray. The total of patients seen and followed in 2012 at Letlhakane Primary Hospital was as followed:

10. Total number of patients co-infected TB/HIV in Letlhakane Primary Hospital 2012 Figure 1

11. . • As shows by the figure number 1,now let calculate the prevalence of TB/HIV patients co-infected per month.

12. .Figure 1

13. . According to the previous table, the period prevalence for co-infected patients in TB/HIV for 2012 in Letlhakane Primary Hospital will be: Period prevalence 2012=(7+6+7+9+6+7+7+9+5+3+7+7)/(12+16+12+20+12+14+16+20+12+12+20+16) =80/182 =0.4395 =43.9%

14. The Pie graph for co-infection in Letlhakane Primary Hospital 2012 Figure 2

15. Let see the pyramid of Patients in Letlhakane Primary Hospital for 2012figure 3

16. Progression of Prevalence of TB/HIV Co-infected patients in Letlhakane Primary Hospital 2012 figure 4

17. . Looking to this result, is like for every 4 patients with HIV positive 1 to 2 patients are co-infected in TB/HIV. Then it is important to talk about the management and the first step will be to promote the most critical infection control measures which are: -Open the windows and doors to improve ventilation

18. . -discharge patients as soon as stable after initiating TB treatment in HIV patients -Triage of coughing patients while waiting to be seen by the doctor • Rapid diagnosis of TB by screening all the HIV patients for TB and all the TB patients for HIV. All the patients co-infected are eligible for HIV treatment regardless CD4 count and TB treatment should start followed by HIV treatment as soon as possible and within 8 weeks after TB treatment.

19. . • TB treatment: -2 months for Isoniazid,Rifampicin,pyrazinamid and Ethambutol -4 months for Isoniazid and Rifampicin As soon as possible introduise HIV treatment : • TDF+FTC+3TC or EFV or as alternative • TDF+FTC+3TC or NVP

20. CONCLUSION • As shows, the Point prevalence of co-infected patients in TB/HIV in Letlhakane Primary Hospital from January to December 2012 ranges from 25% to 58.3%. • the period prevalence for 2012 in Letlhakane primary Hospital Was 43.9% We need to remember that TB in HIV patient is WHO stage 3 or 4 according to the localisation and therefore people living with TB/HIV co-infected are eligible for both treatment regardless CD count.

21. . • Optimal management of dually infected patients will reduce mortality , will improve the patient outcomes and prevent diverse reactions. • health workers suppose to monitor and track the TB and HIV co-infection patients by: -Ensure that all TB patients referred for HIV testing and vice versa.

22. . -Both TB and HIV healthcare facilities should make every effort to document their TB/HIV co-infection prevalence.

23. REFERENCES • Global report: USAIDS report on the global epidemic 2012 • Botswana-Upenn partnership: year-end report 2012 • Botswana HIV/AIDS treatment guidelines 2012 • Botswana TB/HIV policy guidelines 2008 • National directory of HIV and AIDS slake holders in Botswana 2008 • HIV/AIDs treatment and care: clinical protocols in Botswana 2008.