The increasing burden of tuberculosis in rural South Africa--impact of the HIV epidemic.
OBJECTIVE
To determine the impact of the HIV epidemic on tuberculosis caseload in rural South Africa.


METHODS
Hlabisa health district, KwaZulu-Natal.


METHODS
Demographic and clinical data were extracted from the tuberculosis database for the period, May 1991-June 1995. The attributable fraction of HIV-infected tuberculosis cases was estimated from the prevalence of HIV infection in tuberculosis cases and the prevalence of HIV infection in women attending antenatal clinics.


RESULTS
Between 1991 and 1995, the annual tuberculosis caseload increased from 301 to 839 cases. Tuberculosis accounted for 4.7% of all admissions in 1989 and 8.3% in 1995 (P < 0.0001). The incidence of tuberculosis increased from 154/100,000 in 1991, to 413/100,000 in 1995. The proportion with smear-positive pulmonary disease fell from 65% to 56% (P = 0.04), and pleural tuberculosis accounted for 7.5% of disease in 1991 and 18% in 1995 (P = 0.002). The minimum HIV prevalence in patients with tuberculosis increased from 8.7% in 1991 to 28.3% in 1995, and the proportion of tuberculosis cases attributable to HIV infection was estimated to be at least 44% in 1995.


CONCLUSIONS
The burden of HIV-related tuberculosis is increasing rapidly in rural South Africa and is exerting a negative impact. Innovative approaches to control will be needed to cope with it effectively.
Wilkinson
D
D
Centre for Epidemiological Research in Southern Africa, South African Medical Research Council, Hlabisa, KwaZulu-Natal.
Davies
G R
GR
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D015528:HIV Seroprevalence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012423:Rural Health; D017678:Sex Distribution; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology* / Q000382:microbiology