title: Tuberculosis in HIV programmes in lower-income countries: practices and risk factors.
abstract: BACKGROUND
  Tuberculosis (TB) is a common diagnosis in human immunodeficiency virus (HIV) infected patients on antiretroviral treatment (ART).
  
  
  OBJECTIVE
  To describe TB-related practices in ART programmes in lower-income countries and identify risk factors for TB in the first year of ART.
  
  
  METHODS
  Programme characteristics were assessed using standardised electronic questionnaire. Patient data from 2003 to 2008 were analysed and incidence rate ratios (IRRs) calculated using Poisson regression models.
  
  
  RESULTS
  Fifteen ART programmes in 12 countries in Africa, South America and Asia were included. Chest X-ray, sputum microscopy and culture were available free of charge in respectively 13 (86.7%), 14 (93.3%) and eight (53.3%) programmes. Eight sites (53.3%) used directly observed treatment and five (33.3%) routinely administered isoniazid preventive treatment (IPT). A total of 19 413 patients aged ≥ 16 years contributed 13,227 person-years of follow-up; 1081 new TB events were diagnosed. Risk factors included CD4 cell count (>350 cells/μl vs. <25 cells/μl, adjusted IRR 0.46, 95%CI 0.33-0.64, P < 0.0001), sex (women vs. men, adjusted IRR 0.77, 95%CI 0.68-0.88, P = 0.0001) and use of IPT (IRR 0.24, 95%CI 0.19-0.31, P < 0.0001).
  
  
  CONCLUSIONS
  Diagnostic capacity and practices vary widely across ART programmes. IPT prevented TB, but was used in few programmes. More efforts are needed to reduce the burden of TB in HIV co-infected patients in lower income countries.
authors.affiliation: Institute of Social and Preventive Medicine, Berne, Switzerland. lfenner@ispm.unibe.ch
authors.forename: L
authors.initials: L
authors.lastname: Fenner
authors.forename: M
authors.initials: M
authors.lastname: Forster
authors.forename: A
authors.initials: A
authors.lastname: Boulle
authors.forename: S
authors.initials: S
authors.lastname: Phiri
authors.forename: P
authors.initials: P
authors.lastname: Braitstein
authors.forename: C
authors.initials: C
authors.lastname: Lewden
authors.forename: M
authors.initials: M
authors.lastname: Schechter
authors.forename: N
authors.initials: N
authors.lastname: Kumarasamy
authors.forename: M
authors.initials: M
authors.lastname: Pascoe
authors.forename: E
authors.initials: E
authors.lastname: Sprinz
authors.forename: D R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: P S
authors.initials: PS
authors.lastname: Sow
authors.forename: D
authors.initials: D
authors.lastname: Dickinson
authors.forename: M P
authors.initials: MP
authors.lastname: Fox
authors.forename: J
authors.initials: J
authors.lastname: McIntyre
authors.forename: M
authors.initials: M
authors.lastname: Khongphatthanayothin
authors.forename: F
authors.initials: F
authors.lastname: Dabis
authors.forename: M W G
authors.initials: MW
authors.lastname: Brinkhof
authors.forename: R
authors.initials: R
authors.lastname: Wood
authors.forename: M
authors.initials: M
authors.lastname: Egger
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use; D060085:Coinfection; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D016012:Poisson Distribution; D012307:Risk Factors; D012737:Sex Factors; D013183:Sputum / Q000382:microbiology; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D007538:Isoniazid