title: Voluntary counselling, HIV testing and adjunctive cotrimoxazole reduces mortality in tuberculosis patients in Thyolo, Malawi.
abstract: OBJECTIVE
  To assess the feasibility and effectiveness of voluntary counselling, HIV testing and adjunctive cotrimoxazole in reducing mortality in a cohort of tuberculosis (TB) patients registered under routine programme conditions in a rural district of Malawi.
  
  
  METHODS
  'Before' and 'after' cohort study using historical controls.
  
  
  METHODS
  Between 1 July 1999 and 30 June 2000 all TB patients were started on standardized anti-TB treatment, and offered voluntary counselling and HIV testing (VCT). Those found to be HIV-positive were offered cotrimoxazole at a dose of 480 mg twice daily, provided there were no contraindications. Side-effects were monitored clinically. End-of-treatment outcomes in this cohort (intervention group) were compared with a cohort registered between 1 July 1998 and 30 June 1999 in whom VCT and cotrimoxazole was not offered (control group).
  
  
  RESULTS
  A total of 1986 patients was registered in the study: 1061 in the intervention group and 925 in the control cohort. In the intervention group, 1019 (96%) patients were counselled pre-test, 964 (91%) underwent HIV testing and 938 (88%) were counselled post-test. The overall HIV-seroprevalence rate was 77%. A total of 693 patients were given cotrimoxazole of whom 14 (2%) manifested minor dermatological reactions. The adjusted relative risk of death in the intervention group compared with the control group was 0.81 (P < 0.001). The number needed to treat with VCT and adjunctive cotrimoxazole to prevent one death during anti-TB treatment was 12.5.
  
  
  CONCLUSIONS
  This study shows that VCT and adjunctive cotrimoxazole is feasible, safe and reduces mortality rates in TB patients under routine programme conditions.
authors.affiliation: Medecins Sans Frontieres-Luxembourg, Blantyre, Malawi. zachariah@internet.Lu
authors.forename: Rony
authors.initials: R
authors.lastname: Zachariah
authors.forename: Marie-Paule L
authors.initials: MP
authors.lastname: Spielmann
authors.forename: Christina
authors.initials: C
authors.lastname: Chinji
authors.forename: Patrick
authors.initials: P
authors.lastname: Gomani
authors.forename: Victor
authors.initials: V
authors.lastname: Arendt
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Hargreaves
authors.forename: Felix M
authors.initials: FM
authors.lastname: Salaniponi
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003376:Counseling; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis*; D006679:HIV Seropositivity; D006801:Humans; D007223:Infant; D008295:Malawi; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D016016:Proportional Hazards Models; D012423:Rural Health; D012646:Self Administration; D016019:Survival Analysis; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D035141:Voluntary Programs
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination