Characteristics of tuberculosis patients who generate secondary cases.

OBJECTIVE: To determine the characteristics of smear positive tuberculosis (TB) patients who generate secondary TB cases. METHODS: Those smear positive TB patients detected by the Barcelona Tuberculosis Program between 1990-1993, and for whom contact studies had been performed, were studied. We analyzed the predictive role of the variables: age, sex, intravenous drug use (IVDU), the presence of the acquired immune deficiency syndrome (AIDS), human immunodeficiency virus (HIV) infection, radiology pattern, district of residence, history of imprisonment, alcoholism, smoking, history of TB, treatment compliance and the number of secondary cases generated. Statistical analysis was based on the logistic regression model, calculating the odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Of the 1079 patients studied, 78 (7.2%) had generated only one secondary case, and 30 (2.8%) two or more. The variables associated with generating two or more secondary cases were: IVDU (P < 0.001; OR = 4.06; CI: 1.80-9.15), cavitary radiology pattern (P = 0.002; OR = 3.69; CI: 1.62-8.43), and age (P = 0.016; OR = 0.98; CI: 0.96-0.99). When we examined those who had generated one or more secondary cases, the following variables were significant: IVDU (P = 0.043; OR = 1.75; CI: 1.02-3.02), cavitary radiology pattern (P < 0.001; OR = 3.07; CI: 1.98-4.77) and age (P < 0.001; OR = 0.98; CI: 0.97-0.99). CONCLUSION: The study of the contacts of smear positive TB patients allows us to detect an important number of secondary cases. Young adults, those with cavitary radiology pattern, and IVDU are more likely to generate secondary cases.

[Tuberculosis trends in Barcelona (1987-1995). Impact of the human immunodeficiency virus and control measures]. / Evolución de la tuberculosis en Barcelona (1987-1995). Influencia del virus de la inmunodeficiencia humana y de las medidas de control.

BACKGROUND: To study the epidemiology to tuberculosis (TB) in Barcelona, Spain from 1987 to 1995, analyzing the influence of HIV infection and the impact of control measures. PATIENTS, MATERIAL AND METHODS: All cases detected by the Barcelona Tuberculosis Prevention and Control Program were included in the study of the evolution of TB incidence according to different variables. The impact of HIV infection was analyzed through the attributable risk per cent (AR), and control measures through the evolution of the rate of treatment compliance, contact studies, and diagnostic delay. RESULTS: We detected 8,942 patients, 23.2% of whom were found through the active epidemiological surveillance system, representing an average annual incidence of 60.4/100,000. The incidence peaked in 1991 (68.7/100,000) and slowly declined to 55.7/100,000 in 1995. Men showed higher incidence (RR: 2.74; CI 95%: 2.62-2.87), particularly among the young (25-34 years olds), 53.3% of whom were HIV (+). The AR for HIV was 92.7%. In this period there was an increase in TB HIV (+), IVDU, and prisoners. Treatment compliance (80.8% in 1987 to 93.8% in 1995) and contact studies (3.2 studies/case in 1995) evolved favorably, unlike but diagnostic delay (35 days in 1995) did not. CONCLUSIONS: The Active Epidemiological Surveillance System has affored us a clear view of the actual situation regarding TB in Barcelona, Spain. Despite the HIV epidemics and the high number of IVDU, the evolution of TB has shown a steady decline due to improvement in control measures.

[Evaluation of the tuberculosis control programs of the autonomous regions of Spain]. / Evaluación de los programas de control de tuberculosis de las Comunidades Autónomas de España.

BACKGROUND: After the resurgence of tuberculosis in the eighties, several institutions pushed to rapidly create tuberculosis programs and to improve the effectiveness of those in existence. The objective of this paper is to evaluate the programs of the Autonomous Communities of Spain. MATERIAL AND METHODS: A questionnaire was sent to 17 Autonomous Communities and two cities Ceuta and Melilla. A table with minimum objectives was made in order to evaluate the impact of each program. The study period was 1996. RESULTS: The percentage of answers was 100%. Fourteen Autonomous Communities (82%) confirmed they have a tuberculosis program, but with important limitations. There are 3.8 public health workers per 1,000 cases of tuberculosis. Eleven Autonomous Communities had active surveillance, but only 4 know adherence rates to tuberculosis treatments, 3 had supervised treatments, and 3 know diagnostic delays. Ten know results about the percentage of cases with revised contacts. 70% of 19 revised programs did not fulfill the recommended basic objectives. CONCLUSIONS: Tuberculosis control in Spain is not adequate for a developed country. An improvement of the programs in needed, with increase of resources and with reference support centers which would carry out annual evaluations.

Prevalence of HIV infection among young adult injecting and non-injecting heroin users in Spain in the era of harm reduction programmes: gender differences and other related factors.

The aims were to assess the prevalence of HIV infection among young adult heroin users, including injecting heroin users (IHUs) and non-injecting heroin users (NIHUs), and to explore the differences by gender and other factors. The design was a cross-sectional cohort study between April 2001 and December 2003, which included 961 current heroin users (HU), aged 18-30 years: 422 in Madrid, 351 in Barcelona and 188 in Seville; 621 were IHUs and 340 were NIHUs. All were street-recruited by chain referral methods. Face-to-face interviews were conducted using a structured questionnaire with computer-assisted personal interviewing (CAPI). Samples for HIV testing (dried blood spot) were collected and tested with ELISA and Western Blot. Bivariate, logistic regression, and classification and regression tree analyses were performed. The overall prevalence of HIV infection among IHUs was 25.8% (95% CI 22.3-29.3) [32.4% (95% CI 26.6-38.1) in Madrid, 20.5% (95% CI 15.6-25.4) in Barcelona, and 20.6% (95% CI 9.8-31.4) in Seville], whereas in NIHUs it was 4.0% (95% CI 2.1-6.7), with no differences among cities. The prevalence was significantly higher in women than in men in NIHUs (10.9%, 95% CI 4.3-17.5 vs. 1.7%, 95% CI 0.5-4.2) and was non-significantly higher in IHUs (30.4%, 95% CI 23.0-37.8 vs. 24.1%, 95% CI 20.1-28.1). HIV prevalence in short-term IHUs was 12.9% (CI 8.8-17.02), with no differences among cities. In the logistic analysis, the variables associated with infection in IHUs were ever having injected with used syringes (OR 3.4, 95% CI 2.2-5.3), ever having been in prison (OR 2.6, 95% CI 1.6-4.0), and heroin as the first drug injected at least weekly (OR 2.3, 95% CI 1.1-4.5). Factors positively associated with HIV infection in NIHUs were female sex (OR 8.7, 95% CI 2.6-29.2) and age >25 years (OR 3.1, 95% CI 0.9-11.1), while primary educational level was inversely associated (OR 0.26, 95% CI 0.1-0.9). Although there are important geographic differences, HIV prevalence in IHUs remains high, even in short-term IHUs, whereas it was almost six times lower in NIHUs. The prevalence in women is higher than in men, particularly among NIHUs. A wide range of preventive strategies should be developed, aimed primarily at empowering women to negotiate safe sex.

Geographic variation in HIV infection among injecting drug users with Barcelona.

In response to a high incidence of AIDS among injecting drug users in Barcelona, Spain, the city established a program in four geographically distinct centers for assistance and surveillance. The centers provided testing, counseling, and monitoring of infectious diseases. In 1991-92, HIV rates were 33% in the northwest center, 39% in the western center, 39% in the east, and 71% in the south. Differences between the rates in the southern center when compared with those in the other centers were very significant (P < or = .001). These data show geographic variation of HIV infection within one city and substantiate the need to provide expanded medical care in the drug misuse treatment setting.