Treatment outcome of TB/HIV positive and negative smear positive pulmonary tuberculosis patients treated using daily self-administered therapy in a Cameroonian district hospital.

BACKGROUND: In our previous study we found that half of the patients treated at the Nylon District Hospital tuberculosis (TB) treatment centre were seropositive. HIV does not only fuel the number of tuberculosis (TB) cases worldwide but it is also at least in part, responsible for the non-achievement of the 85% cure rate target. OBJECTIVE: To compare the TB treatment outcome of smear positive pulmonary tuberculosis (SPPT) patients who did an HIV test and those who refused the test as well as compare the treatment outcomes between the HIV positive and HIV negative SPPT patients from 2003 to 2005, all of whom were treated as outpatients under routine programme conditions. DESIGN: A retrospective study. SUBJECTS: Four hundred and twenty patients were registered from 2003 to 2005 as having SPPT. SETTING: The Nylon District Hospital, Cameroon. RESULTS: Thirty five point two per cent of the 386 SPPT patients also had HIV. The overall cure rate, default rate and death rate were 69%, 23.6% and 3.3% respectively. SPPT/HIV co-infected patients were significantly more likely to default from treatment (28.7% versus 16.8%, OR 1.943, 95% CI 1.150-3.285) to die in the course of treatment (7.4% versus 0.4%, OR 23.714, 95% CI 2.894-194.330) or not to be cured (58.8% versus 78.8%, OR 0.404, 95% CI 0.250-0.652) compared to SPPT/HIV negative patients. Likewise SPPT patients not tested for HIV were significantly less cured (38.2% versus 71.8%, OR 0.21, 95% CI 0.099-0.445) and defaulted most (52.9% versus 21%, OR 4.773 95% CI 2.281-9.991) compared to SPPT patients tested for HIV. CONCLUSION: SPPT patients infected with HIV or not tested for HIV in the course of TB treatment are likely to suffer from unfavorable treatment outcomes. Thus health personnel prescribing anti- TB drugs should be provided with the necessary expertise to diagnose and manage HIV so that TB/HIV co-infected patients benefit from an integrated package of care in and out of the hospital.

Seroprevalence of human immunodeficiency virus infection among tuberculosis patients in the Nylon district hospital tuberculosis treatment centre.

BACKGROUND: Tuberculosis (TB) incidence in Cameroon is high with 32% of adult TB patients, all forms, co-infected with HIV. The Nylon District Hospital in Douala runs a centre for the diagnosis and treatment of TB since 2001 and a pioneer Human Immunodeficiency Virus (HIV)/Acquired Immune deficiency Syndrome (AIDS) management programme at district level since 2000. OBJECTIVE: To determine the prevalence of HIV infection in TB patients from 2003 to 2006 and to analyse the pattern of TB/HIV co-infection rate over time. DESIGN: A retrospective study. SETTING: Nylon District Hospital, Douala, Cameroon. RESULTS: The prevalence of HIV infection in TB patients was 51.6%. This was greater for patients living out of the Nylon Health District (P = 0.001). Smear positive pulmonary tuberculosis (SPPT) was the most frequent (65%) form of TB diagnosed but extrapulmonary tuberculosis (EPT) and smear negative pulmonary tuberculosis (SNPT) were more frequently associated with HIV co-infection (80% and 68.6% respectively). While men and women presented equally with TB, women (61.4%) were significantly (P < 0.0001) more TB/HIV co-infected than men (42%). The co-infection rate was highest among individuals aged 25-44 years (61.4%) and least among the 0-24 years age group (22.5%). The increase in TB/HIV co-infection rate is monotonic over time with a stronger trend among females aged 25-44 years (P = 0.037) and above 45 years (P = 0.001). CONCLUSION: The NDH selectively attracted HIV positive patients to adhere to their HIV programme. The creation of HIV/AIDS treatment units in institutions providing TB diagnosis and treatment services will reduce the movement of TB/HIV co-infected patients across provinces and health districts as well as enhancing TB/HIV co-infection diagnosis and notification.