학술논문
Finding patients eligible for antiretroviral therapy using TB services as entry point for HIV treatment
Recherche active des patients nécessitant un traitement antirétroviral en utilisant les services de lutte contre la tuberculose comme moyen dʼaccès aux traitements anti-VIH
Encontrando pacientes elegibles para terapia antirretroviral utilizando servicios TB como punto de entrada para tratamiento del VIH
Recherche active des patients nécessitant un traitement antirétroviral en utilisant les services de lutte contre la tuberculose comme moyen dʼaccès aux traitements anti-VIH
Encontrando pacientes elegibles para terapia antirretroviral utilizando servicios TB como punto de entrada para tratamiento del VIH
Document Type
Academic Journal
Source
Tropical Medicine & International Health. Oct 01, 2006 11(10):1567-1575
Subject
Language
English
ISSN
1360-2276
Abstract
OBJECTIVE: To estimate the proportion of antiretroviral therapy (ART) eligible adults (15–49 years) with tuberculosis potentially identifiable through tuberculosis services using a CD4 count below 350 cells/mm as cut-off value for ART initiation. METHODS: Using TB notification rate data, HIV seroprevalence data, and estimates of the size of the adult population (15–49 years) in 18 sub-Saharan African countries with an HIV seroprevalence of > 5%, calculations of the number of ART eligible adults with tuberculosis presenting to tuberculosis services were made. Assumptions were made on the tuberculosis notification rates in the age-group 15–49 years, the HIV-infected population with a CD4 count below 350 cells/mm and the relative risk of developing tuberculosis, and average duration from HIV infection to death. The probability of having a CD4 count below 350 cells/mm given a diagnosis of tuberculosis was estimated using Bayesʼ theorem, and estimates of the number of patients with a CD4 count below 350 cells/mm identifiable through tuberculosis were made. The number needed to screen to identify one ART eligible patient through tuberculosis services was estimated for each country. RESULTS: ART eligible adults with tuberculosis potentially identifiable through tuberculosis services in the 18 countries ranged from 2% to 18% of the total HIV-infected adult population with a CD4 count below 350 cells/mm and would average 10% of all such HIV patients. The number needed to screen to identify ART eligible patients through tuberculosis services ranged from 1.4 to 4.2, against 8.6 to 65.4 if adults aged 15–49 are randomly screened for low CD4 counts. CONCLUSION: Tuberculosis services are an important entry point for identifying ART eligible patients. Given that dually infected patients identified through tuberculosis services contributed to 10% of the HIV-infected adult population with a CD4 cell count below 350 cells/mm in the 18 sub-Saharan African countries, major efforts are required beyond the tuberculosis services in detecting patients that should benefit from ART. However, the low number needed to screen gives opportunity to use tuberculosis services in AIDS control and ART scaling-up programmes.