Understanding the Profile of Tuberculosis and Human Immunodeficiency Virus Coinfection: Insights from Expanded HIV Surveillance at a Tuberculosis Facility in Durban, South Africa
Background. Expanded HIV surveillance in TB patients forms part of the World Health Organization framework for strategic collaborative activity. Surveillance helps understand the epidemiology of the local dual epidemic and enables design of a tailored response to these challenges. Methods. We conducted an observational, cross-sectional study of anonymous unlinked HIV testing for 741 consecutive TB suspects attending an urban TB facility during a seven-week period in 2008. Results. A total of 512 patients were found to have TB. The mean age was 35.7 years, and 63% were male. The prevalence of HIV was 72.2% (95% CI: 68.2–75.9) in all TB cases, 69.8% (95% CI: 65.3–74.2) in pulmonary tuberculosis (PTB), 81.6% (95% CI: 72.9–90.3) in extrapulmonary disease, and 66.8% (95% CI: 60.7–72.9) in those without TB disease. HIV prevalence in TB patients was higher in females than males and in younger age groups (18–29 years). The sex ratio of PTB patients correlated with the sex ratio of the prevalence of HIV in the respective age groups . Conclusion. The use of a rapid HIV test performed on sputum anonymously provides an opportunity for HIV surveillance in this high-burdened setting, which has the potential to lend valuable insight into the coepidemics. 1. Background In South Africa, the global epicenter of both tuberculosis (TB) and human immunodeficiency virus (HIV), the menacing convergence of these diseases: one viral and one bacterial, one emergent, and one ancient, presents a near insurmountable challenge to health, social, economic, and developmental welfare [1]. These dual epidemics threaten to undo the health care gains of the past decades in an already ailing health care system. Women now account for nearly a half of all global infections and 77% of all women living with HIV are in sub-Saharan African [2]. Acquired immune deficiency syndrome (AIDS) accounts for more deaths in women than all causes of maternal mortality combined [2]. While the global incidence of HIV is decreasing, new infections among young women aged 15 to 24 years have steadily increased in South Africa, which is due to multifactorial and complex biological, social, economic and behavioural factors. The World Health Organization (WHO), in an effort to address the challenges of HIV associated TB, has proposed a framework of strategic collaborative activities for TB and HIV services which foster a more comprehensive approach to the synergistic dual epidemics [3]. In settings of generalized HIV and AIDS epidemics, like South Africa, WHO recommends expanding HIV surveillance to include TB
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