RETROSPECTIVE STUDY OF
PREVALENCE OF PATIENTS
TB/HIV CO-INFECTED AT
LETLHAKANE PRIMARY
HOSPITAL (BOTSWANA) IN 2012
TABLE OF CONTENTS
1. Introduction
2. General considerations
3. Methods and discussion about the
prevalence of co-infected patient in
Letlhakane Primary Hospital (2012)
4. Conclusion
5. references
INTRODUCTION
• Since 2004, TB related deaths among people
living with HIV have fallen to 28% in subSaharan Africa, WHO estimate that scaling up
collaborative HIV and TB activities meant that
an estimated 1.3million people avoided dying
from AIDS-related causes from 2005-2011.
.
• The human immunodeficiency virus (HIV)
pandemic presents a massive challenge for global
tuberculosis(TB) control.
• Botswana like other sub-Saharan African
countries experiences a huge burden of TB/HIV
co-infection.
• The dramatic increases in TB incidence over the
past 2 decades is due to the increasing of
prevalence of HIV, at present the country
estimate 60-80% of TB patients co-infected with
HIV.
• Tuberculosis, one of the most opportunistic
infection and leading of morbidity and mortality
in HIV patients.
.
• Botswana has one of the highest rate of HIV
in the word.
Data from the 2008 HIV/AIDS impact survey
shows a prevalence of 17.6% among the general
population and 40% prevalence of HIV among
people aged 30-44years, the first case of HIV in
Botswana was diagnosed in 1985 and by 2009
there were 331000 people HIV positive and
8700 annual HIV/AIDS related death.
GENERAL CONSIDERATIONS
• Co-infection with TB and HIV markedly
increases the mortality and morbidity of both
diseases, and represents ongoing public heath
crisis in Botswana.
Patients with both infections are more likely to
have extra pulmonary TB and so diagnosis of TB
is often difficult, especially in advanced stage of
HIV.
HIV increases the rate of progression of TB
infection to active diseases and increase the risk
of TB recurrence.
.
• People living with HIV have 10% annual risk
of reactivating latent TB infection, compared
to a 10% lifetime risk in HIV negative
individuals, tuberculosis also increases HIV
progression AIDS by decreasing CD4 counts
and increases viral loads.
METHODS AND DISCUSSION ABOUT
CO-INFECTION IN LETLHAKANE
PRIMARY HOSPITAL
• In Letlhakane Primary Hospital year 2012, for all
the patients HIV positive on treatment or not
with symptoms as followed were screened for
TB/HIV co-infection :
- Cough,fever,night sweats, weight lost,
lymphadenopathy of any duration
- In children also included : decreased
playfullness,failure to gain weight and TB exposure
in the house hold
- All patients on ARV treatment with detectable
viral load.
.
• A positive response or finding to any one of
these signs and symptoms requires father
evaluations for TB by providing sputum
samples(2) for smear microscopy (1) for
culture and chest x-ray.
The total of patients seen and followed in
2012 at Letlhakane Primary Hospital was as
followed:
Total number of patients co-infected TB/HIV in Letlhakane Primary Hospital
2012
Figure 1
Month
Jan
Feb
Mar
April
May
June
July
Aug
Sep
October
Nov
Decem
b
Patients
tested
positive
HIV T
B
co
in
f
HIV T
B
co
in
f
HIV T
B
co
in
f
HIV T
B
C
oin
f
HIV T
B
C
oin
f
HIV T
B
C
oin
f
HIV T
B
C
oin
f
HIV T
B
C
oin
f
HIV T
B
C
oin
f
HIV T
B
C
oin
f
HIV T
B
C
oin
f
HIV
010years
0
0
1
0
1
0
0
0
0
0
0
0
2
0
2
0
0
0
1
1
1
1
0
0
1125years
3
1
5
1
4
2
6
2
3
2
2
2
4
2
6
2
2
3
1
0
4
1
4
2
2645years
6
3
6
3
5
4
10
5
5
2
7
4
6
4
6
4
8
1
6
2
7
3
6
3
≥46year
s
3
3
4
2
2
1
4
2
4
2
5
1
4
1
6
3
2
1
4
0
8
2
6
2
Sub
total
12
7
16
6
12
7
20
9
12
6
14
7
16
7
20
9
12
5
12
3
20
7
16
7
Total
12
7
28
1
3
40
2
0
60
2
9
72
3
5
86
4
2
10
2
4
9
12
2
5
8
13
4
6
3
14
6
6
6
16
6
7
3
18
2
8
0
.
• As shows by the figure number 1,now let
calculate the prevalence of TB/HIV patients
co-infected per month.
Month
Jan
Feb
Mar
Apr
May
Jun
July
Aug
Sep
Oct
Nov
Dec
TB positive
7
13
20
29
35
42
49
58
63
66
73
80
HIV positive
12
28
40
60
72
86
102
122
134
146
166
182
Period
Prevalence
58.3%
46%
50%
48.3%
48.6%
48.8%
48%
47.5%
47%
45.2%
43.9%
43.9%
.Figure 1
Prevalence of TB/HIV co-infected patients in Letlhakane
Prim Hosp
70
60
50
40
30
20
10
0
Prevalence of TB/HIV coinfected patients in
Letlhakane Prim Hosp
.
According to the previous table, the period
prevalence for co-infected patients in TB/HIV for
2012 in Letlhakane Primary Hospital will be:
Period prevalence
2012=(7+6+7+9+6+7+7+9+5+3+7+7)/(12+16+12+20
+12+14+16+20+12+12+20+16)
=80/182
=0.4395
=43.9%
The Pie graph for co-infection in
Letlhakane Primary Hospital 2012
Figure 2
HIV patients in Letlhakane
Prim Hosp
TB/HIV co-infected
patients in Letlh Prim
Hosp
Let see the pyramid of Patients in
Letlhakane Primary Hospital for 2012
figure 3
200
180
160
HIV co-infected in Letlh
Prim Hosp
140
120
Patients HIV in Letlh Prim
Hospital
100
80
60
Prevalence of Co-infected
patients in Letlh Prim
Hosp
40
20
0
Letlhakane Primary Hospital
Progression of Prevalence of TB/HIV
Co-infected patients in Letlhakane
Primary Hospital 2012
figure 4
350
300
250
200
TB/HIV co-infected
patients
150
Prevalence of TB/HIV co
infected
100
HIV patients in Letlh Prim
Hosp
50
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
0
.
Looking to this result, is like for every 4 patients
with HIV positive 1 to 2 patients are co-infected
in TB/HIV.
Then it is important to talk about the
management and the first step will be to
promote the most critical infection control
measures which are:
-Open the windows and doors to improve
ventilation
.
-discharge patients as soon as stable after
initiating TB treatment in HIV patients
-Triage of coughing patients while waiting to be
seen by the doctor
- Rapid diagnosis of TB by screening all the HIV
patients for TB and all the TB patients for HIV.
All the patients co-infected are eligible for HIV
treatment regardless CD4 count and TB
treatment should start followed by HIV
treatment as soon as possible and within 8
weeks after TB treatment.
.
• TB treatment:
-2 months for Isoniazid,Rifampicin,pyrazinamid
and Ethambutol
-4 months for Isoniazid and Rifampicin
As soon as possible introduise HIV treatment :
- TDF+FTC+3TC or EFV or as alternative
- TDF+FTC+3TC or NVP
CONCLUSION
• As shows, the Point prevalence of co-infected
patients in TB/HIV in Letlhakane Primary Hospital
from January to December 2012 ranges from 25%
to 58.3%.
• the period prevalence for 2012 in Letlhakane
primary Hospital Was 43.9%
We need to remember that TB in HIV patient is
WHO stage 3 or 4 according to the localisation and
therefore people living with TB/HIV co-infected are
eligible for both treatment regardless CD count.
.
• Optimal management of dually infected
patients will reduce mortality , will improve
the patient outcomes and prevent diverse
reactions.
• health workers suppose to monitor and track
the TB and HIV co-infection patients by:
-Ensure that all TB patients referred for HIV
testing and vice versa.
.
-Both TB and HIV healthcare facilities should
make every effort to document their TB/HIV coinfection prevalence.
REFERENCES
1. Global report: USAIDS report on the global
epidemic 2012
2. Botswana-Upenn partnership: year-end report
2012
3. Botswana HIV/AIDS treatment guidelines 2012
4. Botswana TB/HIV policy guidelines 2008
5. National directory of HIV and AIDS slake holders
in Botswana 2008
6. HIV/AIDs treatment and care: clinical protocols
in Botswana 2008.