Prevalence and incidence rate of tuberculosis among HIV-infected patients enrolled in HIV care, treatment, and support program in mainland Tanzania.

BACKGROUND: Despite improvements in access to antiretroviral therapy (ART), mortality in people living with human immunodeficiency virus (PLHIV) is still high and primarily attributed to tuberculosis (TB) infection. In Sub-Saharan Africa, approximately 80% of HIV-related mortality cases are associated with TB. Relatively little is known about the incidence of TB among PLHIV in Tanzania and the determinant factors. We report the prevalence and incidence rate of confirmed TB and determine association with selected demographic and program-related factors based on data in the national HIV care and treatment program from 2011 to 2014. METHODS: We used the Tanzania National AIDS Control Programme database to obtain information on all HIV clients enrolled in the HIV care and treatment program between January 2011 and December 2014. We analyzed retrospective cohort data to assess the prevalence and TB incidence rate per 1000 person-years. A multivariable Cox proportional hazards regression model was used to estimate hazard ratios and 95% confidence intervals for putatively associated factors. RESULTS: Over 4 years, there were 22,071 confirmed cases of pulmonary TB in 1,323,600 person-years. The overall TB incidence was around 16.7 (95% CI 16.4-16.9) cases per 1000 person-years. The annual incidence rate decreased by 12.4 % from 17.0 (95% CI 16.5-17.4) in 2011 to 14.9 (95% CI 14.5-15.4) in 2014. The TB incidence rate was higher in persons not using ART and in males than in females. The incidence of TB was higher in patients with advanced HIV disease and decreased with increasing age. The overall prevalence of TB was 2.2%, with a peak prevalence of 2.5% in 2013 and was higher among children < 15 years (3.2%) in the same year. CONCLUSION: The study found an overall decrease in the incidence of TB in PLHIV. Our results emphasize the need for early initiation of ART and the provision of TB preventive therapy for those PLHIV without active TB after intensified TB case-finding.

Pediatric HIV care and treatment services in Tanzania: implications for survival.

BACKGROUND: Improving child survival for HIV-infected children remains an important health agenda. We present progress regarding care and treatment services to HIV infected children in Tanzania. METHODS: The National AIDS Control Programme Care and Treatment (CTC 2) database was used to obtain information of all children aged 0-14yearsenrolled in the HIV Care and Treatment Program between January 2011 and December 2014. We assessed eligibility for ART, time from enrolment to ART initiation, nutritional status, and mortality using Kaplan-Meier methods. RESULTS: A total of 29,531 (14,304 boys and 15,227 girls) ART-naive children aged 0-14 years were enrolled during the period, approximately 6700 to 8000 children per year. The male to female ratio was 48:50. At enrolment 72% were eligible for ART, 2-3% of children were positive for TB, and 2-4% were severely malnourished. Between 2011 and 2014, 2368 (8%) died, 9243 (31%) were Lost to Follow-up and 17,920 (61%) were on care or ART. The probability of death was 31% (95% CI 26-35), 43% (40-47), 52% (49-55) and 61% (58-64) by 1,2, 5 and 10 years of age, respectively. The hazard of death was greatest at very young ages (<2 years old), and decreased sharply by 4 years old. Children who were on ART had around 10-15% higher survival over time. CONCLUSIONS: Significant progress has been made regarding provision of paediatric HIV care and treatment in Tanzania. On average 7000 children are enrolled annually, and that approximately two thirds of children diagnosed under the age of 2 years were initiated on ART within a month. Provision of ART as soon as the child is diagnosed is the biggest factor in improving survival. However we noted that i) most children had advanced disease at the time of enrolment ii) approximately two-thirds of children were missing a baseline CD4 measurement and only 35% of children had either a CD4 count or percentage recorded, indicating limited access to CD4 testing services, and iii) 31% were lost to follow-up (LTFU). These challenges need to be addressed to improve early detection, enrolment and retention of HIV-infected children into care and improve documentation of services offered.

Diagnostic values of digital rectal examination, prostate specific antigen and trans-rectal ultrasound in men with prostatism.

OBJECTIVE: To determine the diagnostic values of digital rectal examination (DRE), prostate specific antigen (PSA) and trans-rectal ultrasound (TRUS) individually and in combinations in men aged 50 years and above presenting with prostatism. DESIGN: A prospective, descriptive, cross-sectional, hospital-based study. SETTING: The urology ward of Kilimanjaro Christian Medical Centre (KCMC), a 500 bed tertiary hospital in the Kilimanjaro region, Tanzania. SUBJECTS: Ninety four consecutive admissions of men aged 50 years and above admitted with urinary symptoms suggestive of prostatism. MAIN OUTCOME MEASURES: Primary outcome measures included race and age of patient; Positive predictive values, sensitivities and specificities for DRE, PSA and TRUS individually and in combinations and histology of the prostate specimens submitted after Tru-cut, TURP or open prostatectomy. The secondary outcome measures were mean PSA and PSA density. RESULTS: There was a prostate adenocarcinoma incidence of 25.5%; all found among patients with PSA levels greater than 10 ng/ml. The positive predictive value (PPV), sensitivity and specificity of DRE for prostate cancer were 0.67%, 66.7% and 88.6% with an accuracy of 82.8%; while for TRUS, the respective values were 0.58%, 58.3% and 85.7% with an accuracy of 78.7%. PSA alone had a positive predictive value of 0.16. A combination of abnormal DRE and PSA (more than 4.0 ng/ml) had a positive predictive value (PPV) of 0.75 while when DRE, TRUS and PSA were all abnormal, the PPV rose to 0.80. CONCLUSION: A combination of DRE and PSA yields 75% diagnostic sensitivity for prostate cancer and is reliable enough to exempt TRUS where not available since it only adds 5% to this strong diagnostic combination.