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Characteristics of adults and children diagnosed with tuberculosis in Lilongwe, Malawi: findings from an integrated HIV/TB clinic

Publication year: 
2012
Author (s): 
Feldacker, C. [et al.]
Publication details: 
London, Blackwell Publishing, 2012
Publication in: 
Tropical Medicine and International Health, Volume 17, No. 9; 2012 pp. 1108–1116
Abstract:

Objectives: To describe initial registration characteristics of adult and paediatric TB patients at a large, public, integrated TB and HIV clinic in Lilongwe, Malawi, between January 2008 and December 2010.
Methods: Routine data on patient with TB category and TB type, stratified by HIV and ART status,were used to explore differences in proportions among TB only, TB⁄ HIV co-infected patients not on ART and TB ⁄HIV co-infected patients on ART using chi-square tests. Trends over time illustratestrengths and weaknesses of integrated service provision.
Results: Among 10 143 adults, HIV ascertainment and ART uptake were high and increased over time. The proportion of relapse was highest among those on ART (5%). The proportion of smearpositive pulmonary TB (PTB) was highest among HIV-negative patients with TB (34.9%); extrapulmonary TB (EPTB) was lowest among TB only (16.2%). Among 338 children <15 years, EPTB and smear-positive PTB were more common among TB-only patients. Time trends showed significant increases in the proportion of adults with smear-positive PTB and the proportion of adults already on ART before starting TB treatment. However, some co-infected patients still delay ART initiation.
Conclusions: HIV ascertainment and ART uptake among co-infected patients are successful and improving over time. However, delays in ART initiation indicate some weakness linking TB ⁄HIV patients into ART during TB follow-up care. Improved TB diagnostics and screening efforts, especially for paediatric patients, may help improve quality care for co-infected patients. These results may aid efforts to prioritise TB and HIV prevention, education and treatment campaigns for specific populations.