Targeted and prompt TB screening and HIV treatment provision are lacking
GUADALAJARA, Mexico – Despite a decrease in the numbers of TB cases reported in Kilifi, a rural county in Kenya along the Indian Ocean, deaths from tuberculosis were on the rise.
At a Friday session here, Kenyan researcher Osman Abdullahi described an analysis of the data in a county that is home to sex workers who provide services to tourists in Mombasa and drug users who find drugs easily accessible along the drug trafficking route that ran through his country.
According to Abdullahi, key populations in Kenya that include men who have sex with men as well as commercial sex workers and people who inject drugs are thought to represent at least 44 percent of all new HIV infections in the country, and where HIV is found in Kenya, tuberculosis is not far behind.
Half of all women in Kilifi who earn income from selling sex are HIV-infected and 20 percent of residents who use drugs live with HIV. Abdullahi and colleagues analyzed the records of nearly 8,800 persons who had entered care for tuberculosis in the previous five years and found that 29 percent of them were co-infected with HIV, 86 percent of them completed treatment and 471 died. More than half of those 471 whose deaths were recorded died within two months of completing TB treatment, he said, and nearly 70 percent of deaths occurred within three months of treatment.
“The case fatality ratio was driven by HIV infection,” Abdullahi noted, “TB patients who were co-infected with HIV were more than three times as likely to die as those who did not have HIV.”
The patients with HIV who were also receiving antiretroviral therapy and /or cotrimoxazole to prevent infections were forty times less likely to die than those who were not. Other factors that were associated with higher risk of death included increasing age.
“Only 31 percent of adults were being screened for TB during HIV clinic visits,” stated Abdullahi, “And TB preventive therapy was only offered to 58 percent of adults with HIV. “
TB and HIV public health intervention programs targeting these key populations are very limited in Kilifi and should be recommended, he concluded.