AEGiS-13IAC: The current status of 12 African nations with respect totuberculosis and AIDS.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

The current status of 12 African nations with respect totuberculosis and AIDS.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrC189)

Shandera W
W. Shandera, Baylor College of Medicine - BTGH, 1 Baylor Plaza, Houston, Texas, 77030, United States, Tel.: +1 713 793 3560, Fax: +1 713 798 6400, E-mail: shandera@bcm.tmc.edu

BACKGROUND: The current status of tuberculosis (TB) policies among African nations is poorly understood, despite over million deaths from TB annually among 20+ million with AIDS.

METHODS: To increase knowledge about African TB policies, we surveyed in 1998/9 all African nations re TB/AIDS case loads for 1996/7, ascertaining treatment policies, isolate resistance, mortality data, and control measures.

RESULTS: Twelve nations provided data ( Btsw, CVI, CdI, Djib, Mali, Marts, Mzbq, Rwnd, Sngl, Sych, Zmba, Zmbw ), with a total annual TB case load > 132,000. About 61% were new cases, 4.9% relapsed, 4.4% transferred from other areas, and 1.5% failure of therapy. 5/12 nations used smears for dx, the other 7 a combination of radiologic, microbiologic, and other means. 7.7% of cases were extrapulmonary on dx. Routine chemoprophylaxis for skin test positive patients was used only in the Seychelles, for the HIV +. 67% of ministries recommended use of 4+ agents for initial therapy, most often INH, Rif, and PZA (all 12), then ethambutol and streptomycin (7), and thiacetazone (1, CVI ). Maintenance rx was most often with INH (12), then Rif (7), ethambutol (5), and thiacetazone (3, CVI, Mzbq, Sngl ). B6 rx w INH was considered routine for 75% or more of cases in only 3 nations. Shortage of medications were reported by 3 nations ( Mali:Eth, Zmba, Zmbbw:INH / Rif ). TB was reportable in all 11, HIV in 9, AIDS in 10. Short course therapy used in all 12 nations, for smear positive in 8. Desired detection of cases rate was 65-85% for 8 nations and > 85% for 4. The desired treatment rate was 75%+ for 10 nations. DOT used by all 12 nations, TB hospitals by 8, special TB wards by 5, with median stay 2 months. Among 1996 cases at time of survey, 30% were cured, 24% completed therapy, 8.7% were deceased, 1.7% failed therapy, 11.3% had not completed therapy, and 7.1% transferred to other units. Other control measures included home visits in 8, pill counts in 4, obligatory sanitarium admissions in 3, and use of community supervisors in 3. Obligatory testing was limited to student in Mali & Sychl, pts of HIV-infected MDs in Sychl. BCG was required in all by MBA, was given at birth in 7 and > 5 months in 9. Est mortality for adults was 4% (median) with highest values from MBA (18%) & Zmbw (25%).

CONCLUSIONS: TB remains a grave problem throughout Africa. Consensus about its management exists. In most areas 4 drugs are given for initial therapy. Shortages of agents are infrequent. Initial therapy is commonly with INH, PZA, rifampin, streptomycin, and ethambutol, and maintenance with INH, rifampin, and ethambutol, and rarely thioacetazone. DOT is nearly universal. Other control measures are diverse, suggesting a consensus for prevention and control is needed as it has been reached for therapy.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, Isoniazid, Tuberculosis, HIV Infections, Rifampin, Ethambutol, Thioacetazone, HIV Seropositivity, Drug Therapy, Combination, Africa, Mali, Seychelles, Adult, Human, therapy, drug therapy
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MoOrC189