Abstract
BackgroundSmear-positive pulmonary TB is the most infectious form of TB. Previous studies on the effect of HIV and antiretroviral therapy on TB treatment outcomes among these highly infectious patients demonstrated conflicting results, reducing understanding of important issues.MethodsAll adult smear-positive pulmonary TB patients diagnosed between 2008 and 2010 in Malawi’s largest public, integrated TB/HIV clinic were included in the study to assess treatment outcomes by HIV and antiretroviral therapy status using logistic regression.ResultsOf 2,361 new smear-positive pulmonary TB patients, 86% had successful treatment outcome (were cured or completed treatment), 5% died, 6% were lost to follow-up, 1% failed treatment, and 2% transferred-out. Overall HIV prevalence was 56%. After adjusting for gender, age and TB registration year, treatment success was higher among HIV-negative than HIV-positive patients (adjusted odds ratio 1.49; 95% CI: 1.14–1.94). Of 1,275 HIV-infected pulmonary TB patients, 492 (38%) received antiretroviral therapy during the study. Pulmonary TB patients on antiretroviral therapy were more likely to have successful treatment outcomes than those not on ART (adjusted odds ratio : 1.83; 95% CI: 1.29–2.60).ConclusionHIV co-infection was associated with poor TB treatment outcomes. Despite high HIV prevalence and the integrated TB/HIV setting, only a minority of patients started antiretroviral therapy. Intensified patient education and provider training on the benefits of antiretroviral therapy could increase antiretroviral therapy uptake and improve TB treatment success among these most infectious patients.
Highlights
One third of the world’s population is infected with tuberculosis (TB) bacilli and at risk of developing active TB [1]
Setting The study was conducted at the Martin Preuss Centre (MPC), an integrated TB/HIV clinic run by the Malawi Ministry of Health’s Lilongwe District Health Office in partnership with the Lighthouse Trust
Study Population Between January 2008 and December 2010, 2,478 new, smearpositive, adult pulmonary TB (PTB) cases were registered at MPC
Summary
One third of the world’s population is infected with tuberculosis (TB) bacilli and at risk of developing active TB [1]. Smear-positive pulmonary TB (PTB) constitutes 34% of new TB cases [2] and is most likely a source of TB transmission in the community. In sub-Saharan Africa, high HIV prevalence increases the risk of developing TB. An estimated 40% of African TB cases were HIV co-infected in 2010, and 24% of 1.45 million TB deaths globally were among HIV-infected people [1]. Due to the high HIV prevalence among TB patients, WHO recommends the Three I’s: intensified TB screening among HIVinfected individuals, provision of isoniazid preventive therapy (IPT), and infection control [3]. Malawi’s national HIV programme started providing IPT among pre-ART patients in 2011 [4]. Smear-positive pulmonary TB is the most infectious form of TB. Previous studies on the effect of HIV and antiretroviral therapy on TB treatment outcomes among these highly infectious patients demonstrated conflicting results, reducing understanding of important issues
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