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High Rates of Tuberculosis in Patients Accessing HAART in Rural South Africa – Implications for HIV and TB Treatment Programs . Kogieleum Naidoo on behalf of

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High Rates of Tuberculosis in Patients Accessing HAART in Rural South Africa – Implications for HIV and TB Treatment Programs

KogieleumNaidoo

on behalf of

Quarraisha Abdool Karim, Ambika Bhushan , Kasavan Naidoo, Nonhlanhla Yende-Zuma, Patricia K Mchunu, Janet Frohlich, Farina Karim, Michele Upfold, Paul Kocheleff and Salim S Abdool Karim

Abstract no. TUPDB0101

background
Background
  • 1.1 million HIV associated TB cases and 350 000 deaths among TB-HIV co-infected patients, in 2010
  • Evidence supports TB screening and diagnosis, and HAART initiation early during TB therapy in co-infected patients
  • Burden of undiagnosed TB at HAART initiation and number of new TB cases diagnosed during HAART in settings with a high HIV and TB burden not fully measured
  • Study aim: To measure TB prevalence and incidence rates and impact on clinical outcomes among rural patients accessing HAART in a TB - HIV endemic setting
methods
Methods

Prospective cohort study among 969 HIV-positive patients initiating HAART, conducted between January 2007 and December 2010

HAART eligibility included confirmed HIV status, CD4+ count < 200 cells/mm3, or presence of WHO stage 4 condition

TB was diagnosed based on a positive TB symptom screen; TB smear microscopy; and diagnostic radiology. Culture and drug susceptibility testing was limited

Tuberculin Skin Testing and isoniazid preventive therapy (IPT) was not available during the study period

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Study definitions:

    • ‘prevalent TB’ on TB treatment at HAART initiation.
    • ‘Incident TB’ new TB cases diagnosed after HAART initiation,
    • Incident TB was further classified into “unmasked TB” defined as a new TB diagnosis within 3 months of HAART initiation, and
    • “incident TB” defined as a new TB diagnosis occurring between 4 and 24 months post HAART initiation
conclusion
Conclusion
  • Unacceptably high TB incidence rates, in a rural HAART program in a TB HIV endemic setting
    • irrespective of baseline immunologic status of patients at HAART initiation,
    • duration on HAART
    • reflecting on-going susceptibility to TB, and on-going TB transmission
  • High rates of prevalent TB especially among patients with CD4< 50 cells/mm3
  • Findings highlight the need for enhanced TB screening and diagnosis, and need for programmatic implementation of TB preventive therapy especially among HIV infected patients in TB endemic settings

Acknowledgement

  • Financial support for CAPRISA was from the National Institute of Allergy and infectious Disease (NIAID), National Institutes of Health (NIH) (grant# AI51794); patient care and treatment has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centres for Disease Control and Prevention, grant number 1U2GPS001350; Dr Naidoo was supported by the Columbia University-Southern African Fogarty AIDS International Training and Research Program grant#  D43TW00231.