AEGiS-14IAC: Continued increase of HIV-related tuberculosis and impact of the improved TB control program on prevalence of drug resistant TB, Chiang Rai, Thailand.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Continued increase of HIV-related tuberculosis and impact of the improved TB control program on prevalence of drug resistant TB, Chiang Rai, Thailand.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no.. B10246)

Yanai H, Supawitkul S, Uthaivoravit W, Rienthong D, Yoshiyama T, Khuptarat R, Sawanpanyalert P
TB/HIV Research Project, Chiang Rai, Thailand

BACKGROUND: There is limited information about the epidemiological trend and impact of tuberculosis (TB) control program improvement in the HIV epidemic area in Asia.

METHODS: A population-based surveillance study was set up. Provincial TB registry data since 1987 together with 6-month treatment results was computerized. HIV voluntary counseling and testing, and drug sensitivity testing were instituted and have been an integral part of the surveillance system since 1996. Chi-square for trend was used to test whether there is a significant trend or not.

RESULTS: The incidence rates of new TB per 100,000 populations were 63 in 1987 and 50 in 1990 and increased to 117 in 1999 and 140 in 2000. Among TB patients in 1999, 43% were HIV-positive 32% were negative and 25% were unknown. The number of relapse cases increased slightly from 20 in 1989 to 30 in 1999 and 31 in 2000. Default rates of new smear positive cases decreased over the time, i.e. 24.2%, 20.7%, 15.4%, 11.5%, and 5.2% in 1995, 1996, 1997, 1998, and 1999, respectively (p<0.001). The rates of transfer-out, however, increased over the same period, i.e. 5.3, 6.8%, 7.8%, 10.7%, and 13.2%, respectively (p<0.001). Out of the 269 transferred out AFB-positive pulmonary TB cases in 1995-1999, 18.6% did not show up at the referred hospital. Rate of primary multi-drug resistant TB was 6.9% in 1996-97, 5.7% in 1998, and 2.8% in 1999-2000 (p=0.001).

CONCLUSION: Despite the recent decline in HIV incidence and prevalence, HIV epidemic still has long-term impacts as reflected by the increase of TB cases in this province. However, the number of relapse cases did not increase appreciably, possibly due to the high mortality of TB cases and improved TB control program. Default rate has declined after the implementation of DOTS, but still needs further improvement, especially among transferred-out cases. Rate of drug resistance might reflect the improved TB control program and need further monitoring.

Keywords: AEGIS, Tuberculosis, Prevalence, HIV Infections, Mycobacterium tuberculosis, Tuberculosis, Pulmonary, HIV Seropositivity, Incidence, Population Surveillance, Disease Outbreaks, Thailand, Asia, Human, epidemiology

020707
B10246