Abstract
BackgroundZimbabwe is a Southern African country with a high HIV-TB burden and is ranked 19th among the 22 Tuberculosis high burden countries worldwide. Recurrent TB is an important problem for TB control, yet there is limited information about treatment outcomes in relation to HIV status. This study was therefore conducted in Chitungwiza, a high density dormitory town outside the capital city, to determine in adults registered with recurrent TB how treatment outcomes were affected by type of recurrence and HIV status.MethodsData were abstracted from the Chitungwiza district TB register for all 225 adult TB patients who had previously been on anti-TB treatment and who were registered as recurrent TB from January to December 2009. The Chi-square and Fischer's exact tests were used to establish associations between categorical variables. Multivariate relative risks for associations between the various TB treatment outcomes and HIV status, type of recurrent TB, sex and age were calculated using Poisson regression with robust error variance.ResultsOf 225 registered TB patients with recurrent TB, 159 (71%) were HIV tested, 135 (85%) were HIV-positive and 20 (15%) were known to be on antiretroviral treatment (ART). More females were HIV-tested (75/90, 83%) compared with males (84/135, 62%). There were 103 (46%) with relapse TB, 32 (14%) with treatment after default, and 90 (40%) with "retreatment other" TB. There was one failure patient. HIV-testing and HIV-positivity were similar between patients with different types of TB. Overall, treatment success was 73% with transfer-outs at 14% being the most common adverse outcome. TB treatment outcomes did not differ by HIV status. However those with relapse TB had better treatment success compared to "retreatment other" TB patients, (adjusted RR 0.81; 95% CI 0.68 - 0.97, p = 0.02).ConclusionsNo differences in treatment outcomes by HIV status were established in patients with recurrent TB. Important lessons from this study include increasing HIV testing uptake, a better understanding of what constitutes "retreatment other" TB, improved follow-up of true outcomes in patients who transfer-out and better recording practices related to HIV care and treatment especially for ART.
Highlights
Zimbabwe is a Southern African country with a high human immunodeficiency virus infection (HIV)-TB burden and is ranked 19th among the 22 Tuberculosis high burden countries worldwide
The global burden of tuberculosis (TB) is highest in the Sub-Saharan Africa region [1] and this can be attributed to the high prevalence of human immunodeficiency virus infection (HIV) which is known to increase the risk of developing TB [2,3]
Results of HIV testing and documented referral of HIV-infected TB patients to antiretroviral treatment (ART) are shown in Additional file 1: Figure S1
Summary
Zimbabwe is a Southern African country with a high HIV-TB burden and is ranked 19th among the 22 Tuberculosis high burden countries worldwide. The global burden of tuberculosis (TB) is highest in the Sub-Saharan Africa region [1] and this can be attributed to the high prevalence of human immunodeficiency virus infection (HIV) which is known to increase the risk of developing TB [2,3]. In the WHO Africa region, the annual number of notified retreatment TB cases had increased from 15,133 in 1995 to 135,564 by the end of 2008, with 53,190 being relapse cases and 82,374 being registered in other retreatment categories [1]. Zimbabwe, which ranks 19th among the 22 Tuberculosis high burden countries, had a TB incidence rate of 762 cases per 100,000 population and an HIV co-infection prevalence of above 75% in 2008 [1]. There were 3631 (10%) notified retreatment cases out of a total of 36,650 cases registered in 2008, and these cases had a treatment success rate that was reported at 73% compared to 69% and 74% for new smear-positive TB cases and new-smear negative/extra-pulmonary TB cases respectively [1]
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