The burden and treatment of HIV in tuberculosis patients in Papua Province, Indonesia: a prospective observational study

BMC Infectious Diseases

Research Article

Nicholas M Anstey¹  Ric N Price²  Anna P Ralph³  Gysje J Pontororing⁴  Enny Kenangalem⁵  Paul M Kelly⁶  Emiliana Tjitra⁷  Dina B Lolong⁷  Govert Waramori⁸ 

[1] Global Health Division, Menzies School of Health Research, Darwin, Australia;Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia;Global Health Division, Menzies School of Health Research, Darwin, Australia;Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia;Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK;Global Health Division, Menzies School of Health Research, Darwin, Australia;National Centre for Epidemiology and Population Health Research, Australian National University, Canberra, Australia;Menzies School of Health Research-National Institute of Health Research and Development Research Program, Timika, Papua, Indonesia;Menzies School of Health Research-National Institute of Health Research and Development Research Program, Timika, Papua, Indonesia;District Health Authority, Timika, Papua, Indonesia;National Centre for Epidemiology and Population Health Research, Australian National University, Canberra, Australia;National Institute of Health Research and Development, Jakarta, Indonesia;Public Health & Malaria Control Department, PT Freeport Indonesia, Timika, Papua, Indonesia;

关键词: Isoniazid Preventive Therapy;    Cavitary Disease;    Papua Province;    Lower Exercise Tolerance;    Sputum Smear Conversion;   

DOI  :  10.1186/1471-2334-10-362

 received in 2010-09-30, accepted in 2010-12-24,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundNew diagnoses of tuberculosis (TB) present important opportunities to detect and treat HIV. Rates of HIV and TB in Indonesia's easternmost Papua Province exceed national figures, but data on co-infection rates and outcomes are lacking. We aimed to measure TB-HIV co-infection rates, examine longitudinal trends, compare management with World Health Organisation (WHO) recommendations, and document progress and outcome.MethodsAdults with newly-diagnosed smear-positive pulmonary TB managed at the Timika TB clinic, Papua Province, were offered voluntary counselling and testing for HIV in accordance with Indonesian National Guidelines, using a point-of-care antibody test. Positive tests were confirmed with 2 further rapid tests. Study participants were assessed using clinical, bacteriological, functional and radiological measures and followed up for 6 months.ResultsOf 162 participants, HIV status was determined in 138 (85.2%), of whom 18 (13.0%) were HIV+. Indigenous Papuans were significantly more likely to be HIV+ than Non-Papuans (Odds Ratio [OR] 4.42, 95% confidence interval [CI] 1.38-14.23). HIV prevalence among people with TB was significantly higher than during a 2003-4 survey at the same TB clinic, and substantially higher than the Indonesian national estimate of 3%. Compared with HIV- study participants, those with TB-HIV co-infection had significantly lower exercise tolerance (median difference in 6-minute walk test: 25 m, p = 0.04), haemoglobin (mean difference: 1.3 g/dL, p = 0.002), and likelihood of cavitary disease (OR 0.35, 95% CI 0.12-1.01), and increased occurrence of pleural effusion (OR 3.60, 95% CI 1.70-7.58), higher rates of hospitalisation or death (OR 11.80, 95% CI 1.82-76.43), but no difference in the likelihood of successful 6-month treatment outcome. Adherence to WHO guidelines was limited by the absence of integration of TB and HIV services, specifically, with no on-site ART prescriber available. Only six people had CD4+ T-cell counts recorded, 11 were prescribed co-trimoxazole and 4 received ART before, during or after TB treatment, despite ART being indicated in 14 according to 2006 WHO guidelines.ConclusionsTB-HIV co-infection in southern Papua, Indonesia, is a serious emerging problem especially among the Indigenous population, and has risen rapidly in the last 5 years. Major efforts are required to incorporate new WHO recommendations on TB-HIV management into national guidelines, and support their implementation in community settings.

【 授权许可】

Unknown   
© Pontororing et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.