Autor/a:
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Haraka, Frederick; Glass, Tracy R.; Sikalengo, George; Gamell, Anna; Ntamatungiro, Alex J.; Hatz, Christoph; Tanner, Marcel; Furrer, Hansjakob; Battegay, Manuel; Letang, Emilio
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Abstract:
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OBJECTIVES: To report on trends of tuberculosis ascertainment
among HIV patients in a rural HIV cohort in Tanzania, and
assessing the impact of a bundle of services implemented in
December 2012, consisting of three components:(i)integration of
HIV and tuberculosis services; (ii)GeneXpert for tuberculosis
diagnosis; and (iii)electronic data collection. DESIGN:
Retrospective cohort study of patients enrolled in the Kilombero
Ulanga Antiretroviral Cohort (KIULARCO), Tanzania.). METHODS:
HIV patients without prior history of tuberculosis enrolled in
the KIULARCO cohort between 2005 and 2013 were included.Cox
proportional hazard models were used to estimate rates and
predictors of tuberculosis ascertainment. RESULTS: Of 7114 HIV
positive patients enrolled, 5123(72%) had no history of
tuberculosis. Of these, 66% were female, median age was 38
years, median baseline CD4+ cell count was 243 cells/microl, and
43% had WHO clinical stage 3 or 4. During follow-up, 421
incident tuberculosis cases were notified with an estimated
incidence of 3.6 per 100 person-years(p-y)[95% confidence
interval(CI)3.26-3.97]. The incidence rate varied over time and
increased significantly from 2.96 to 43.98 cases per 100 p-y
after the introduction of the bundle of services in December
2012. Four independent predictors of tuberculosis ascertainment
were identified:poor clinical condition at baseline (Hazard
Ratio (HR) 3.89, 95% CI 2.87-5.28), WHO clinical stage 3 or 4
(HR 2.48, 95% CI 1.88-3.26), being antiretroviralnaive (HR 2.97,
95% CI 2.25-3.94), and registration in 2013(HR 6.07, 95% CI
4.39-8.38). CONCLUSION: The integration of tuberculosis and HIV
services together with comprehensive electronic data collection
and use of GeneXpert increased dramatically the ascertainment of
tuberculosis in this rural African HIV cohort. |