Depression and associated factors among HIV-positive smokers receiving care at HIV outpatient clinics in Vietnam: a cross-sectional analysis

OBJECTIVES

To assess the prevalence of depressive symptoms and associated factors among people living with HIV (PLWH) who were current cigarette smokers and receiving treatment at HIV outpatient clinics (OPCs) in Vietnam.

DESIGN

A cross-sectional survey of smokers living with HIV.

SETTING

The study was carried out in 13 HIV OPCs located in Ha Noi, Vietnam.

PARTICIPANTS

The study included 527 PLWH aged 18 and above who were smokers and were receiving treatment at HIV OPCs.

OUTCOME MEASURES

The study used the Centre for Epidemiology Scale for Depression to assess depressive symptoms. The associations between depressive symptoms, tobacco dependence and other characteristics were explored using bivariate and Poisson regression analyses.

RESULTS

The prevalence of depressive symptoms among smokers living with HIV was 38.3%. HIV-positive smokers who were female (prevalence ratio, PR 1.51, 95% CI 1.02 to 2.22), unmarried (PR 2.06, 95% CI 1.54 to 2.76), had a higher level of tobacco dependence (PR 1.06, 95% CI 1.01 to 1.11) and reported their health as fair or poor (PR 1.66, 95% CI 1.22 to 2.26) were more likely to have depression symptoms compared with HIV-positive smokers who were male, married, had a lower level of tobacco dependence and self-reported their health as good, very good or excellent.

CONCLUSION

The prevalence of depressive symptoms among smokers receiving HIV care at HIV OPCs was high. Both depression and tobacco use screening and treatment should be included as part of ongoing care treatment plans at HIV OPCs.

State of the Science of Scale-Up of Cancer Prevention and Early Detection Interventions in Low- and Middle-Income Countries: A Scoping Review

PURPOSE

Cancer deaths in low- and middle-income countries (LMICs) will nearly double by 2040. Available evidence-based interventions (EBIs) for cancer prevention and early detection can reduce cancer-related mortality, yet there is a lack of evidence on effectively scaling these EBIs in LMIC settings.

METHODS

We conducted a scoping review to identify published literature from six databases between 2012 and 2022 that described efforts for scaling cancer prevention and early detection EBIs in LMICs. Included studies met one of two definitions of scale-up: (1) deliberate efforts to increase the impact of effective intervention to benefit more people or (2) an intervention shown to be efficacious on a small scale expanded under real-world conditions to reach a greater proportion of eligible population. Study characteristics, including EBIs, implementation strategies, and outcomes used, were summarized using frameworks from the field of implementation science.

RESULTS

This search yielded 3,076 abstracts, with 24 studies eligible for inclusion. Included studies focused on a number of cancer sites including cervical (67%), breast (13%), breast and cervical (13%), liver (4%), and colon (4%). Commonly reported scale-up strategies included developing stakeholder inter-relationships, training and education, and changing infrastructure. Barriers to scale-up were reported at individual, health facility, and community levels. Few studies reported applying conceptual frameworks to guide strategy selection and evaluation.

CONCLUSION

Although there were relatively few published reports, this scoping review offers insight into the approaches used by LMICs to scale up cancer EBIs, including common strategies and barriers. More importantly, it illustrates the urgent need to fill gaps in research to guide best practices for bringing the implementation of cancer EBIs to scale in LMICs.

Adapting a tobacco cessation treatment intervention and implementation strategies to enhance implementation effectiveness and clinical outcomes in the context of HIV care in Vietnam: a case study

BACKGROUND

Smoking rates remain high in Vietnam, particularly among people living with HIV/AIDS (PLWH), but tobacco cessation services are not available in outpatient HIV clinics (OPCs). The research team is conducting a type II hybrid randomized controlled trial (RCT) comparing the cost-effectiveness of three tobacco cessation interventions among PLWH receiving care in HIV clinics in Vietnam. The study is simultaneously evaluating the implementation processes and outcomes of strategies aimed at increasing the implementation of tobacco dependence treatment (TDT) in the context of HIV care. This paper describes the systematic, theory-driven process of adapting intervention components and implementation strategies with demonstrated effectiveness in high-income countries, and more recently in Vietnam, to a new population (i.e., PLWH) and new clinical setting, prior to launching the trial.

METHODS

Data collection and analyses were guided by two implementation science frameworks and the socio-ecological model. Qualitative interviews were conducted with 13 health care providers and 24 patients in three OPCs. Workflow analyses were conducted in each OPC. Qualitative data were analyzed using rapid qualitative analysis procedures. Based on findings, components of the intervention and implementation strategies were adapted, followed by a 3-month pilot study in one OPC with 16 patients randomized to one of two intervention arms.

RESULTS

The primary adaptations included modifying the TDT intervention counseling content to address barriers to quitting among PLWH and Vietnamese sociocultural norms that support smoking cessation. Implementation strategies (i.e., training and system changes) were adapted to respond to provider- and clinic-level determinants of implementation effectiveness (e.g., knowledge gaps, OPC resource constraints, staffing structure, compatibility).

CONCLUSIONS

Adaptations were facilitated through a mixed method, stakeholder (patient and health care provider, district health leader)-engaged evaluation of context-specific influences on intervention and implementation effectiveness. This data-driven approach to refining and adapting components aimed to optimize intervention effectiveness and implementation in the context of HIV care. Balancing pragmatism with rigor through the use of rapid analysis procedures and multiple methods increased the feasibility of the adaptation process.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05162911 . Registered on December 16, 2021.

The implementation of rifapentine and isoniazid (3HP) in two remote Arctic communities with a predominantly Inuit population, the Taima TB 3HP study

Background: The incidence of TB among Inuit is the highest in Canada. A significantly shorter latent TB infection (LTBI) treatment with rifapentine and isoniazid once weekly for 12 weeks (3HP) is now available in limited settings in Canada.Methods: A prospective open-label 2-year observational postmarketing study was conducted introducing 3HP for the first time in Canada in Iqaluit followed by a program rollout in Qikiqtarjuaq, Nunavut.Results: A total of 247 people were offered 3HP, 102 in the Iqaluit postmarketing study and 145 in the Qikiqtarjuaq program roll out. Although statistical significance was not reached, more people who started treatment completed treatment in the 3HP group (Iqaluit, 60/73 (82.2%) and Qikiqtarjuaq, 89/115 (77.4%)) than in the historical control 9INHgroup (306/420 = 72.9%) (p = 0.2). Most of the adverse events in 3HP treated patients were associated with mild discomfort but no disruption of normal daily activity. Not drinking alcohol was associated with increased 3HP completion (OR 13.33, 95% CI, 2.27-78.20) as was not taking concomitant medications (OR 7.19, 95% CI, 1.47-35.30).Conclusions: The present study supports the feasibility and safety profile of 3HP for the treatment of LTBI in Nunavut.

Seven-year retrospective study understanding the latent TB infection treatment cascade of care among adults in a low incidence country

Background

Prevention of TB is paramount to achieving elimination targets as recommended by the World Health Organization’s action framework for low incidence countries striving to eliminate TB. Although the rates of TB in Canada are low, understanding the latent TB infection (LTBI) cascade is paramount to identifying gaps in care and treatment barriers, thereby increasing the effectiveness of preventive strategies. The purpose of this study was to examine the LTBI cascade of care and identify barriers to treatment completion in adults referred from primary care to a regional tertiary care TB clinic in Ottawa, Canada.

Methods

Electronic medical records between January 2010 and December 2016 were reviewed retrospectively and an LTBI cascade of care was constructed from The Ottawa Hospital TB clinic and surrounding primary care clinics. A cohort of 2207 patients with untreated LTBI was used to ascertain the associations between demographic and clinical factors for both treatment non-initiation and non-completion using log-binomial univariable and multivariable regression models.

Results

Of 2207 patients with untreated LTBI who were seen in the clinic during the study period, 1771 (80.2%) were offered treatment, 1203 (67.9% of those offered) started treatment, and 795 (66.1% of those started) completed treatment. In multivariable analysis, non-initiation of treatment was associated with older age (adjusted risk ratio [aRR] 1.06 per 5-year increase, 95% CI: 1.03–1.08) and female gender (aRR 1.28, 95% CI: 1.11–1.47). Non completion of treatment was associated with referral from the TB Clinic back to the primary care team following initial consult (aRR 1.62, 95% CI: 1.35–1.94) and treatment with the standard of 9 months of Isoniazid (9H) compared to 4 months of Rifampin (4R) (aRR 1.45, 95% CI:1.20–1.74).

Conclusions

LTBI treatment completion was significantly decreased among patients who were referred back to primary care from the TB clinic. The 4R regimen resulted in more people completing LTBI treatment compared to 9H in keeping with a recently published RCT. Improved education, communication, and collaboration between tertiary care TB clinics and primary care teams may improve treatment completion rates and address the TB burden in low incidence communities in Canada.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10733-9.

A case of relapsed Mycobacterium chelonae pulmonary infection presenting with severe weight loss and treated with a combination of antibiotic therapy and percutaneous feeding

Mycobacterium chelonae is a type of nontuberculous mycobacteria most commonly associated with skin and soft tissue infections. We present a case of recurrent M. chelonae pulmonary infection presenting with severe weight loss. After recurrence, sputum cultures remained positive for 2 years despite appropriate antibiotics. Cultures only became negative after the addition of intravenous imipenem and jejunostomy feeds. The rarity of M. chelonae pulmonary infection means that optimal treatment regimens have not yet been fully established but a regimen of clarithromycin plus an additional antibiotic has been recommended¹. The prognosis of such infections also remains unclear but lower rates of macrolide resistance suggest that the prognosis may be better than the closely related species M. abscessus. Although its benefit has not been proven, nutrition supplementation, including percutaneous enteral feeding, can be considered for refractory NTM infection in underweight patients.

The Prevalence and Covariates of Food Insecurity Across Gestation and Postpartum Among Women of Mixed HIV Status in Nyanza Region, Kenya

Objectives

Food insecurity (FI) is recognized as an important predictor of a range of health outcomes, including HIV acquisition and progression. Less is understood about the drivers of FI during the first 1000 days. Therefore we assessed the prevalence and covariates of FI among women of mixed HIV status in southwestern Kenya from pregnancy to 21 months postpartum.

Methods

The prevalence of FI was measured amongst all pregnant women attending 7 antenatal clinics in the Nyanza region, Kenya (n = 954) between 2015 and 2017 using the Individually Focused Food Insecurity Access Scale (IFIAS, range: 0–27). Subsequently, equal proportions of HIV-infected and -uninfected pregnant women (n = 363) were enrolled into an observational study and surveyed at 9 timepoints.

Results

In the population-based sample, 81% were severely food insecure. In the study cohort, the mean (SD) IFIAS score was 15.4 (6.1); 88% were considered severely food insecure. In longitudinal logistic regression models of FI (severe vs. not severe) from pregnancy to 21 m postpartum, greater depression scores, lower social support, greater stress, rural residence, and having dependents under 15-years were associated with greater IFIAS scores. Surprisingly, HIV infection, gestation age, education, and maternal age did not predict IFIAS scores.

Conclusions

These findings suggest programs in severely food insecure communities should also address psychosocial well-being of women to improve health outcomes.

Funding Sources

National Institute of Mental Health (K01 MH098902 and R21MH108444).

Paediatric tuberculosis among the foreign-born: utility of the Canadian TB immigration medical surveillance programme

BACKGROUND

There are few data on the utility of screening paediatric immigrants for tuberculosis (TB) in low TB burden countries.

OBJECTIVE

To evaluate the utility of the Canadian immigration medical examination and TB Medical Surveillance (TBMS) for detecting paediatric TB disease.

DESIGN

A 10-year population-based retrospective cohort study of foreign-born children (ages 0-10 years) and adolescents (ages 11-17 years) immigrating to Ontario, Canada, using linked immigration and public health databases.

RESULTS

Among 232 169 individuals (median follow-up of 5.7 years), active TB was diagnosed at or after immigration in 125 cases (20 children and 105 adolescents), at an overall rate of 54/100 000 (14/100 000 children, 116/100 000 adolescents). All cases originated from 34 countries. Active TB was diagnosed in 0/419 children and 10/418 adolescents referred for medical surveillance, representing only 8.0% of all cases. TBMS referrals were correlated with a previous diagnosis of TB (κ = 0.8) and were driven by country of origin (e.g., hazard ratio 31.2 for the Philippines). Rates of pre-immigration TB diagnosis varied considerably among high TB burden countries.

CONCLUSIONS

The current Canadian system detects little TB disease, and reveals very different rates of pre-immigration paediatric TB diagnosis in different high TB burden countries. These data provide a basis for improving TB screening strategies for immigrants to low TB burden countries.

Primary care pearls to help eliminate tuberculosis in Canada

Although Canada has a low incidence of tuberculosis (TB), certain populations, including the foreign-born and Canadian-born Indigenous peoples, continue to be disproportionately represented among reported cases. The overall incidence rates of active TB in Canada have not significantly changed in the past decade and work still needs to be done to reach TB elimination goals set by the World Health Organization (WHO). In trying to achieve TB elimination in Canada, primary care clinicians, with the support of public health professionals and TB experts, can help by focusing on 1) targeted screening and treatment of latent TB infection (LTBI) and 2) timely diagnosis and referral of active TB disease. The following article focuses on some key primary care considerations to keep in mind in day-to-day patient care. To help conduct targeted screening and treatment for LTBI, several key populations, including immigrants from high TB burden countries, Indigenous peoples and several other at-risk groups, are outlined. Reactivation of LTBI plays a significant role in TB burden and is likely an area of major potential impact in achieving TB elimination. Advancement in LTBI treatment, including short course therapy, is also described. In addition, to help make a timely diagnosis of active TB, several key risk factors, including several co-morbidities which increase the risk of developing TB disease, can be considered. Being front-line in patient care, keeping in mind some of these key pearls may aid primary care providers to have potential impact on eliminating TB in Canada.

Sputum induction for tuberculosis diagnosis in an Arctic setting: a cost comparison

SETTING

Tuberculosis (TB) incidence was 234 per 100 000 in Nunavut, Canada, in 2012. Until recently, some individuals seen in local clinics for presumed TB required costly air evacuation to Southern Canada (Ottawa) for investigation if they were unable to produce sputum spontaneously.

OBJECTIVE

To estimate the cost per individual evaluated for TB, associated with the establishment of a sputum induction programme in Iqaluit, Nunavut, Canada.

DESIGN

A decision analysis model compared the total cost per individual for two strategies: 1) initial investigation in Iqaluit, with transport to Ottawa for those requiring sputum induction; and 2) sputum induction at the hospital in Iqaluit, with further investigation in Ottawa only if needed. The model simulated diagnostic and treatment paths from the initial clinic visit to completion of TB investigation or treatment (when applicable).

RESULTS

The estimated cost per person evaluated for TB with sputum induction in 1) Ottawa vs. 2) Iqaluit was CAD4798 (95% uncertainty range 2923-6650) vs. CAD2479 (1206-4256), respectively. Total costs were influenced by underlying TB prevalence, but local sputum induction consistently yielded cost savings.

CONCLUSION

Providing sputum induction in a high-incidence Arctic community such as Iqaluit is projected to generate substantial cost savings in the investigation and management of individuals with presumed TB.

Diagnostic accuracy and clinical role of rapid C-reactive protein testing in HIV-infected individuals with presumed tuberculosis in South Africa

OBJECTIVE

To determine the accuracy and role of rapid C-reactive protein (CRP) testing in human immunodeficiency virus (HIV) infected individuals with presumed tuberculosis (TB).

DESIGN

We enrolled HIV-infected adults (≥18 years)with a cough of ≥2 weeks and negative sputum smears for acid-fast bacilli in KwaZulu-Natal, South Africa. Participants were evaluated for pulmonary TB (PTB) by a nurse with rapid CRP, and independently by a physician by chest radiograph. Rapid CRP test results were compared with laboratory CRP and sputum sent for confirmation of TB.

RESULTS

Among 93 participants, 55 (59%) were female, the mean age was 35 years, and the median CD4 count was 177/mm3. Forty-five (54%) participants were diagnosed with PTB. Diagnostic sensitivity and specificity were respectively 95% (95%CI 74–99) and 51%(95%CI 35–66) for rapid CRP >8 mg/l, 87% (95%CI 73–96) and 53% (95%CI 38–68) for nurse assessment, and 69% (95%CI 52–83) and 76% (95%CI 61–87) for physician examination. Combining a negative rapid CRP(≤8 mg/l) with nurse and physician assessments reduced the post-test probability of PTB from 22% to 6% and from 32% to 6%, respectively.

CONCLUSION

Rapid CRP testing helped exclude PTB,and may be a valuable test in assisting nurses and physicians in TB-endemic regions.

Effective screening tool to triage recovery rooms for possible tuberculosis patients undergoing bronchoscopy

SETTING

In 2005, tuberculin skin test conversions were observed following exposure to a patient with active pulmonary tuberculosis (TB) who recovered post-bronchoscopy in an open area at The Ottawa Hospital, Canada. In response, we implemented a screening tool to triage patients to an airborne infection isolation (AII) room pre- and post-bronchoscopy.

OBJECTIVE

To evaluate the performance of the screening tool in detecting patients with culture-confirmed TB.

DESIGN

All bronchoscopies performed between 1 March 2006 and 31 March 2010 were retrospectively reviewed.

RESULTS

Of 1839 patients included (55.3% of bronchoscopies), 210 screened positive, capturing 28 culture-confirmed TB cases. Three patients with positive TB cultures screened negative. The sensitivity of the screening tool was 90.3%; the negative predictive value was 99.8%. A positive screening result was strongly predictive of a positive TB culture.

CONCLUSIONS

The screening tool is effective for identifying high-risk patients and triaging them to AII rooms. The pre-bronchoscopy screening tool is simple and inexpensive to implement and has the potential to reduce intra-institutional spread of TB.

Pediatric tuberculosis immigration screening in high-immigration, low-incidence countries

BACKGROUND

Tuberculosis (TB) screening in migrant children, including immigrants, refugees and asylum seekers, is an ongoing challenge in low TB incidence countries. Many children from high TB incidence countries harbor latent TB infection (LTBI), and some have active TB disease at the point of immigration into host nations. Young children who harbor LTBI have a high risk of progression to TB disease and are at a higher risk than adults of developing disseminated severe forms of TB with significant morbidity and mortality. Many countries have developed immigration TB screening programs to suit the needs of adults, but have not focused much attention on migrant children.

OBJECTIVE

To compare the TB immigration medical examination requirements in children in selected countries with high immigration and low TB incidence rates.

DESIGN

Descriptive study of TB immigration screening programs for systematically selected countries.

RESULTS

Of 18 eligible countries, 16 responded to the written survey and telephone interview.

CONCLUSION

No two countries had the same approach to TB screening among migrant children. The optimal evidenced-based manner in which to screen migrant children requires further research.

"Crack lung and heart" presenting after chemotherapy in a 65-year-old man with non-Hodgkin lymphoma

Crack cocaine can cause a variety of pulmonary and cardiac complications. Pulmonary findings in a 65- year-old man with non-Hodgkin lymphoma who presented with shortness of breath not resolving with antibiotics are presented here. The usual manifestation of “crack lung” in an unusual clinical circumstance underlines the importance of a clinical history in such cases. The finding of “crack lung” preceded the diagnosis of probable “crack heart.” No other similar published case reports could be identified in the literature.

Tuberculosis retreatment category predicts resistance in hospitalized retreatment patients in a high HIV prevalence area

SETTING

Rates of multidrug-resistant tuberculosis (MDR-TB) are currently as high as 7.7% in retreatment cases in KwaZulu-Natal, South Africa. MDR-TB prevalence is known to be high in patients categorized as treatment failures. Recent reports have questioned the effectiveness of the World Health Organization (WHO) Category II regimen in retreatment TB cases.

OBJECTIVE

To determine whether treatment category predicts susceptibility patterns and outcomes in a hospitalized population of retreatment TB cases.

DESIGN

Retrospective cohort of 197 pulmonary retreatment cases.

RESULTS

Retreatment cases treated with the standard retreatment regimen had a high in-hospital mortality (19.8%), or poor outcome (26.4%) and a high rate of MDR-TB (16.2%). The 'treatment failure' category predicted resistance, with 57.1% of patients exhibiting any resistance compared to other treatment categories (P = 0.02); 53.8% of patients with any resistance experienced poor outcomes, compared to 16.6% of pan-susceptible cases (P = 0.02). There was a trend towards poor outcome in the treatment failure category (42.9%, P = 0.13).

CONCLUSION

The retreatment category 'treatment failure' is associated with a high prevalence of resistance in an area of high human immunodeficiency virus (HIV) prevalence. The 'treatment failure' category should be used to identify patients who may benefit from alternative regimens using directed, intensified therapy or second-line agents instead of the current standard retreatment regimen.

Blastomycosis in a young African man presenting with a pleural effusion

Blastomyces dermatitidis is a dimorphic fungus endemic to north-western Ontario, Manitoba and some parts of the United States. The fungus is also endemic to parts of Africa. Pulmonary and extrapulmonary findings of a 24-year-old African man who presented with weight loss, dry cough and chronic pneumonia not resolving with antibiotic treatment are presented. The unusual occurrence of pulmonary blastomycosis associated with skin lesions and a moderate pleural effusion is reported.

A systematic review of the psychological risk factors associated with near fatal asthma or fatal asthma

Psychological factors such as anxiety, depressive disorders and/or personality disorders may predispose patients with asthma to near fatal asthma (NFA) or fatal asthma (FA). NFA is defined by an asthma exacerbation resulting in respiratory arrest requiring mechanical ventilation or a pCO(2) >or=45 mm Hg. Most studies have used the case-control study design. Several studies analyzing the effects of psychological factors on the risk of NFA or FA have shown conflicting results. We reviewed all of the literature found by the systematic search done of psychological factors on the risk NFA or FA. A MEDLINE search identified 423 articles between 1960 and March 2006. Seven case-controlled studies were identified following strict applications of the inclusion and exclusion criteria. Due to the significant heterogeneity in the measurement of the psychological factors, a summary statistic was not calculated. The trial characteristics were tabulated and qualitative trends were observed to explain the heterogeneity in the results of the studies. Recommendations on future studies in the field are outlined in detail. Following a systematic assessment of all published studies, we cannot conclude that psychological factors increase the risk of NFA and FA.

A systematic review of risk factors associated with near-fatal and fatal asthma

BACKGROUND

Asthma mortality and morbidity continue to be a serious global problem. Systematic reviews provide an opportunity to review risk factors in detail.

OBJECTIVE

To review all of the literature for risk factors associated with near-fatal asthma (NFA) and fatal asthma (FA).

METHODS

A literature search from 1960 to January 2004 in MEDLINE and EMBASE was conducted. Studies were included based on the following criteria: NFA was defined as an asthma exacerbation resulting in respiratory arrest requiring mechanical ventilation or a partial pressure of CO2 of at least 45 mmHg or asthma resulting in death (FA); the study reported the number of cases (NFA and/or FA) and asthmatic controls; there was explicit reporting of risk factors; cases that were adult and pediatric in nature; and all study types. Studies that included patients with chronic obstructive pulmonary disease were excluded.

RESULTS

Four hundred and three articles were identified, of which 27 met the inclusion criteria. Increased use of medications such as beta-agonists via metered dose inhalers (OR=1.67, 95% CI 0.99 to 2.84, P=0.057) and nebulizers (OR=2.45, 95% CI 1.52 to 3.93, P=0.0002), oral steroids (OR=2.71, 95% CI 1.34 to 5.51, P=0.006) and oral theophylline (OR=2.02, 95% CI 1.03 to 3.98, P=0.04) and a history of hospital (OR=2.62, 95% CI 1.04 to 6.58, P=0.04) and/or intensive care unit (OR=5.14, 95% CI 1.91 to 13.86, P=0.001) admissions and mechanical ventilation (OR=6.69, 95% CI 2.80 to 15.97, P=0.0001) due to asthma were predictors of NFA and FA. Prior emergency department assessment did not confer a greater risk of NFA and FA (OR=1.13, 95% CI 0.43 to 2.92, P=0.810). The use of inhaled corticosteroids (ICS) measured in a dose-independent fashion (did the patient take ICS previously; yes or no) inferred equivocal risk of NFA and FA (OR=1.31, 95% CI 0.83 to 2.05, P=0.25). However, two studies measured the use of ICS in a dose-dependent fashion (ie, measured the number of prescriptions filled within the previous six to 12 months). Both studies showed a trend toward a protective effect against FA. One study showed that the premature cessation of ICS can hasten death.

CONCLUSIONS

In the present study, risk factors of NFA and FA have been more accurately defined. Clinicians should identify patients with these characteristics to reduce their risk of NFA and FA. Further research should focus on quantifying the impact of risk factors on asthma deaths.

Tuberculosis at Edendale Hospital in Pietermaritzburg, Kwazulu Natal, South Africa

SETTING

Edendale Hospital, Pietermaritzburg, KwaZulu Natal, South Africa, a 1275-bed hospital that serves a mainly ethnic African population of 1.6 million.

OBJECTIVE

To describe the demographic and clinical characteristics of hospitalised active tuberculosis (TB) cases, and correlates of their in-hospital survival.

METHODS

A retrospective cohort study of adult TB cases admitted to the medical wards, 16 November to 13 December 2001.

RESULTS

Of 760 (28%) admissions, 215 had active TB, of whom 26.5% died in hospital. Patients were mostly young, first diagnosed on admission, and had pulmonary TB. Human immunodeficiency virus (HIV) co-infection was common and predicted by lower absolute lymphocyte count (OR 1.2, 95% CI 1.05-1.38). Extra-pulmonary TB, including pleural and pericardial, was significantly associated with not having HIV infection. In-hospital death was predicted by TB diagnosed prior to admission (OR 3.18, 95% CI 1.67-6.07), acquired immune-deficiency syndrome (AIDS) associated disease, and higher total leukocyte count--by higher leukocytes only in patients without AIDS (OR 8.52, 95% CI 2.67-27.13).

CONCLUSION

Active TB was common in in-patients at an acute care hospital. TB patients presented late in disease and had high in-hospital mortality. Early detection and effective treatment of active TB in the community is likely to reduce hospitalisation and improve survival.