Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 13274-13278 141

Results: 1806 patients (mean age 28.6 ~ 6.1), male (45%) were enrolled Objectives: The aim is to establish district-based projects which will evaluate
within the five year period. The HIV-1 seroprevalence rates were as follows: the feasibility, acceptability and cost-effectiveness of community contribution to
effective TB care as part of NTP activities.
1993 1994 1995 1996 1997 Methods: WHO operational research protocol development workshops were
HIV-1 rate (%) 65.40 70. 8% 61. 2% 42.5% 433% held in Entebbe in November 1996 and Nairobi in March 1997. Investigators
Sputum positive rate 64%o 65%' 82% 82%0 86% in the participating countries (Botswana, Kenya, Malawi, Namibia, South Africa,
Uganda, Zambia) developed, in collaboration with TB experts from WHO, CDC,
USAID, IUATLD, KNCV, and UNAIDS, protocols to evaluate the community
The sputum cultures also showed high yield of MTB from 52 to 83%. contribution to TB bare in the district setting.
Conclusion: HIV-1 seroprevalence is on the decline among Ugandan PTB Results: District-based projects, began late 1997 and will last 2-3 years, and
adults over this five year period. The rise in positive sputum rates and high yield are evaluating a variety of community approaches to TB care, including the use
in culture indicates improvement in diagnostic acumen within the clinic, of established HIV/AIDS community care volunteers, community health workers,
and community volunteers. The projects will evaluate the feasibility of develop-- ing and sustaining the community approach, determine the cure rate and other
615*/ 13274 Multidrugs resistant TB (MRTB): Study of an standard TB treatment outcomes, and measure the cost-effectiveness of the comoutbreak in HIV patients munity approach in comparison with that of the current approach. The methods
Oscar GarciaMecinal 2, M. Ambrogg3, G. Ortega2, S.M. Oliva2, L. Redini2 for qualitative assessments of acceptability include focus group discussions and
S. Poggi3, J. Benetucci2. Vidt 2069 20 A 1425 Buenos Aires 2Hospital Muiz interviews involving patients, community members and health personnel.
Ward 17/Foundation; 3Hospital Muniz (Microbacteria Lab) Buenos Aires, Conclusion: The lessons learned from these projects will guide the formulation
Argentina of policies on the community contribution to effective TB care as part of NTP activities. Successful demonstration of community contribution to effective TB care
Objective: To analyse the characteristics of an MRTB intranosocomial outbreak. in the particular setting of high TB/HIV burden countries in sub-Saharan Africa
Methods: Between 1992 and 1997, 367 patients hospitalized in our center may lead to more widespread, general application of the approach elsewhere,
were infected by Mycobacterium tuberculosis (MT), 124 of whom (34.1%) fulfilled utilising various community groups depending on the particular setting.
the criteria for MRTB (resistance to isoniazid and rifampin). 118 of them (95.2%) tWorking group of the WHO/CDC/USAID project "Community Tuberculosis
were male and 6 (4.8%) were female. Their average age was 31.6; 92 (74.2%) Care in Africa": N Billo (IUATLD), NJ Binkin (CDC), A Bloom (USAID, T Kenyon
were IVDU and 95 (76.6%) are already dead. (CDC), D Maher (WHO/GTB), E McCray (CDC), F Mubiru (UNAIDS consultant),
Results: During 1992 3/41 TB admission (7.3%) got MRTB and in 1997, 19/47 E Nyarko (WHO/AFRO), M Raviglione (WHO/GTB), J Van Gorkom (KNCV).
(40.4%) got the infection. TB was the first AIDS defining illness in 49 patients
and 79.8% had CD4 cells counts below 200/mm3. 107/124 (86.3%) had lung
involment and 16 (12.9%) had positive blood cultures for MT. The susceptibility 612*/13277 Multiple tuberculosis episodes in HIV infected
test done in patients with MRTB showed resistance to ethambutol (78%), pyraz- individuals: Is there a need for secondary
inamide (83%), streptomycin (64%), kanamycin (83%), amikacin (92%), PAS chemoprophylaxis?
(1.7%), cicloserine (1.9%) and ciprofloxacin (7.1%). 14 samples were sensitive to Samuel E. Kalluvya, E.N. Mkumbo, M. Shinano. Bugando Medical Centre P
ofloxacin and clofazimine. From 1992 to 1994 the mortality rate was 100% but in Box 1370 Mwanza, Tanzania Mkumbedical Centre
1997 it was 21.1%. The patients who died had an average survival of 2.9 months
(after they got the TB infection). If we relate mortality to TB clinical forms, we find Objective: To determine and compare the intervals between subsequent TB
that 80/107 (74.7%) patients with lung involvement have died while the mortality episodes after successful treatment in HIV infected and HIV seronegative TB
rate was 81.2% (13/16) in patients with positive blood cultures (p = 0.57). Among patients.
patients that had an association of lung and meningeal, pleural or cutaneous Methods: Charts of TB patients with multiple TB episodes treated at BMC
involvement, mortality was 100%. between 1990 and 1996 were reviewed retrospectively. HIV seronegative individConclusion: The incidence of MRTB is high in our hospital and more frequent uals with multiple episodes served as controls.. The interval between TB episodes
in IVDU patients. Lung involvement is the most frequent clinical form. Prevalence was defined as the lapsed time between date of completion of treatment (with
of positive blood cultures is high. Mortality is higher in patients with more than both negative sputa for AFB and negative cultures), and date of diagnosis of subone organ involved. Multidrug resistance rates are high. sequent TB episode. Treatment of a first TB episode was with the 2HRZE/6EH
and for retreatment 2SHRZE/1HRZE/6HRE respectively.
132 5 Result: Of 34 HIV/TB patients, 32 met the case definition criteria for AIDS.
13275 Factors contributing to reported high defaulter rates Thirty had two while four had three TB episodes. Thirty HIV seronegative TB
among patients on tb treatment patients served as controls. The mean duration between TB episodes was 7.1
Joseph Kamanga. University Teaching Hospital, Zambart Project Department of months (SD 2.9) among HIV infected compared to 91.9 months (SD 49.9) obMedicine, BOX 50110, Lusaka, Zambia, Zambia served among HIV seronegative patients (p < 0.001 95 CI 66.9-102.7 months)
Atypical radiographic features were observed in 23 HIV/TB patients compared to
Issue: In Lusaka urban of Zambia up to 35% of patients have been recorded as 7 among HIV seronegative patients (p < 0.004). Extrapulmonary TB was noted
defaulters in a cohort, in 18 of HIV/TB patients compared to 5 among HIV seronegatives (p = 0.003).
Project: A cross sectional retrospective review of TB records and observa- Conclusion: In advanced clinical stages the immune status is far below the
tional of care given to TB patients was done at one of the health centers with a thresholds for containment of most opportunistic infections, making it easier for
larger TB case load. Suspected defaulters were visited and interviewed. Focus them to re-emerge and cause further episodes. TB episodes recurring few months
group discussions were done with defaulters, those just commenced and about after successful TB treatment raise questions on the adequacy of treatment regito complete treatment, members of health committee and health staff, mens used in clearing m. tuberculosis in HIV disseminated TB and lends support
Results: The incidence of TB in 1996 was 47/10,000. The actual defaulter rate for secondary chemoprophylaxis.
was 9.8%. Those who died represented 18% while 35.5% had left residence.
20% gave false address. 10.7% were regularly taking drugs. 5.6% could not be
reached. DOTS was not strictly followed. Patients complained of long waiting 450*/13278 Cost-effectiveness of isoniazid preventive therapy
time. Component of health education was lacking. Fear of divorce contributing to for HIV-infected people in sub-Saharan Africa
non adherence among women. Those who did not improve were associated with Henry Sacks D.N. Rose2, School of
Lessons Learned: Poor statistics are largely responsible for reported high Medicine, New York, NY; 2Long Island Jewish Hosptal, New Hyde Park NY USA
defaulter rates. From other findings in the study DOTS is not being practiced Objective: To perform a cost-effectiveness analysis of isoniazid preventive thercorrectly. Participation of peer educators and family members could improve apy (IPT) for human immunodeficiency virus (HIV)-infected Sub-Saharan African
compliance, adults with positive tuberculin skin tests.
Methods: We used a Markov transition-state model, the results of a Ugandabased IPT clinical trial and literature-derived medical care costs.
|614*/13276 Evaluating community contribution to effective Outcome measures: Life expectancy, tuberculosis (TB) episodes, and costtuberculosis care in high HIV prevalence effectiveness ratios.
populations Results: IPT decreases the lifetime incidence of TB cases by 36%, extends life
Dermot Mahert, E. Nyarko2. 1 World Health Organization, Global Tuberculosis expectancy by 0.82 years, and costs US $36 per life-year saved. Under optimistic
Programme. 20, Avenue Appia, CH-1211, Geneva, Switzerland; 2World Health assumptions regarding effectiveness in the years following IPT and the costs of
Organizationmme, Regional Office of Africa, Hararene, Zimbabwe IPT and treating TB and IPT adverse effects, IPT decreases the lifetime incidence
ot TB cases by 63%, extends life expectancy by 4.99 years, and reduces total
Background: Tuberculosis (TB) is a leading cause of death worldwide among medical care costs. Under pessimistic assumptions, IPT decreases the lifetime

people infected with HIV. The internationally recommended approach to TB con- incidence of TB cases by only 18%, minimally shortens life expectancy and introl is labour and resource intensive and relies on general health services, which creases medical care costs by US $31 per person. The most important variables
are increasingly unable to cope with the HIV-fuelled TB epidemic in sub-Saharan are the costs of IPT and TB treatment and effectiveness in the years following IPT.
Africa. WHO, CDC and USAID have joined forces with the National Tubercu- Conclusions: IPT decreases the lifetime incidence of TB cases and costs US
losis Programmes (NTPs) in seven countries in sub-Saharan Africa to assess $36 per life-year saved for HIV-infected Sub-Saharan African adults with positive
whether decentralisation of TB care to the community may be a possible way of tuberculin skin tests. IPT could both save lives and reduce total medical care
overcoming these limitations. costs if the cost of preventive therapy could be moderately reduced.