Abstract
BackgroundThe Stop TB Partnership target for tuberculosis is to have reduced the prevalence of tuberculosis by 50% comparing 2015 to 1990. This target is challenging as few prevalence surveys have been conducted, especially in high burden tuberculosis and HIV countries. Current tuberculosis control strategies in high HIV prevalent settings are therefore based on limited epidemiological evidence and more evidence is needed from community-based surveys to inform improved policy formulation.Methods and Findings8044 adults were sampled from 2 sub-districts (wards) in Lusaka province, Zambia. Questionnaires were used to screen for symptoms, respiratory samples were obtained for culture and oral secretions collected for HIV testing. 79 individuals were found to have Mycobacterium tuberculosis in their sputum, giving an adjusted overall prevalence of tuberculosis of 870/100,000 (95% CI 570–1160/100,000). The adjusted overall prevalence of HIV was 28.61% (95% CI 26.04–31.19). HIV- infection was significantly associated with prevalent tuberculosis (Adj OR 2.3, 95% CI 1.42–3.74) and the population attributable fraction of HIV for prevalent tuberculosis was 36%. Symptoms such as prolonged cough (adj OR 12.72, 95% CI 7.05–22.94) and fever (Adj OR 2.04, 95%CI 1.23–3.39), were associated with prevalent tuberculosis, but 8 (10%) individuals with prevalent tuberculosis denied having any symptoms at all and only 34 (43%) would have been classified as a TB suspect by current guidelines.ConclusionsUndiagnosed tuberculosis is a challenge for tuberculosis control and new approaches are needed if we are to reach international targets. Epidemiological studies can inform screening algorithms for both detection and prevention of active tuberculosis.
Highlights
Undiagnosed tuberculosis is a challenge for tuberculosis control and new approaches are needed if we are to reach international targets
Tuberculosis is one of the major causes of morbidity and mortality in poor countries, especially sub-Saharan Africa [1], and is included as one of the diseases covered by the sixth Millennium Development Goal
In order to meet this target the Stop TB Partnership has published a new Stop TB Strategy [3]. This strategy acknowledges that DOTS is still the backbone of global tuberculosis control but that there needs to be increased effort to address the convergence of tuberculosis and HIV, in sub-Saharan Africa where many patients notified with TB are co-infected with HIV
Summary
Tuberculosis is one of the major causes of morbidity and mortality in poor countries, especially sub-Saharan Africa [1], and is included as one of the diseases covered by the sixth Millennium Development Goal. In order to meet this target the Stop TB Partnership has published a new Stop TB Strategy [3] This strategy acknowledges that DOTS is still the backbone of global tuberculosis control (with targets of finding 70% of new smear positive cases of tuberculosis and curing 85% of them) but that there needs to be increased effort to address the convergence of tuberculosis and HIV, in sub-Saharan Africa where many patients notified with TB are co-infected with HIV. The Stop TB Partnership target for tuberculosis is to have reduced the prevalence of tuberculosis by 50% comparing 2015 to 1990 This target is challenging as few prevalence surveys have been conducted, especially in high burden tuberculosis and HIV countries. Current tuberculosis control strategies in high HIV prevalent settings are based on limited epidemiological evidence and more evidence is needed from community-based surveys to inform improved policy formulation
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