Voluntary Counselling, HIV Testing and Adjunctive Cotrimoxazole Reduces Mortality in Tuberculosis Patients in Thyolo, Malawi.

Hdl Handle:
http://hdl.handle.net/10144/18280
Title:
Voluntary Counselling, HIV Testing and Adjunctive Cotrimoxazole Reduces Mortality in Tuberculosis Patients in Thyolo, Malawi.
Authors:
Zachariah, R; Spielmann M P; Chinji, C; Gomani, P; Arendt, V; Hargreaves, N J; Salaniponi, F M L; Harries, A D
Journal:
AIDS (London, England)
Abstract:
OBJECTIVES: To assess the feasibility and effectiveness of voluntary counselling, HIV testing and adjunctive cotrimoxazole in reducing mortality in a cohort of tuberculosis (TB) patients registered under routine programme conditions in a rural district of Malawi. DESIGN: 'Before' and 'after' cohort study using historical controls. METHODS: Between 1 July 1999 and 30 June 2000 all TB patients were started on standardized anti-TB treatment, and offered voluntary counselling and HIV testing (VCT). Those found to be HIV-positive were offered cotrimoxazole at a dose of 480 mg twice daily, provided there were no contraindications. Side-effects were monitored clinically. End-of-treatment outcomes in this cohort (intervention group) were compared with a cohort registered between 1 July 1998 and 30 June 1999 in whom VCT and cotrimoxazole was not offered (control group). FINDINGS: A total of 1986 patients was registered in the study: 1061 in the intervention group and 925 in the control cohort. In the intervention group, 1019 (96%) patients were counselled pre-test, 964 (91%) underwent HIV testing and 938 (88%) were counselled post-test. The overall HIV-seroprevalence rate was 77%. A total of 693 patients were given cotrimoxazole of whom 14 (2%) manifested minor dermatological reactions. The adjusted relative risk of death in the intervention group compared with the control group was 0.81 (P < 0.001). The number needed to treat with VCT and adjunctive cotrimoxazole to prevent one death during anti-TB treatment was 12.5. INTERPRETATION: This study shows that VCT and adjunctive cotrimoxazole is feasible, safe and reduces mortality rates in TB patients under routine programme conditions.
Affiliation:
Medecins Sans Frontieres-Luxembourg, Blantyre, Malawi. zachariah@internet.Lu
Issue Date:
2-May-2003
URI:
http://hdl.handle.net/10144/18280
DOI:
10.1097/01.aids.0000060355.78202.b7
PubMed ID:
12700456
Language:
en
ISSN:
0269-9370
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorZachariah, R-
dc.contributor.authorSpielmann M P-
dc.contributor.authorChinji, C-
dc.contributor.authorGomani, P-
dc.contributor.authorArendt, V-
dc.contributor.authorHargreaves, N J-
dc.contributor.authorSalaniponi, F M L-
dc.contributor.authorHarries, A D-
dc.date.accessioned2008-02-14T11:44:15Z-
dc.date.available2008-02-14T11:44:15Z-
dc.date.issued2003-05-02-
dc.identifier.citationVoluntary Counselling, HIV Testing and Adjunctive Cotrimoxazole Reduces Mortality in Tuberculosis Patients in Thyolo, Malawi. 2003, 17 (7):1053-61 AIDSen
dc.identifier.issn0269-9370-
dc.identifier.pmid12700456-
dc.identifier.doi10.1097/01.aids.0000060355.78202.b7-
dc.identifier.urihttp://hdl.handle.net/10144/18280-
dc.description.abstractOBJECTIVES: To assess the feasibility and effectiveness of voluntary counselling, HIV testing and adjunctive cotrimoxazole in reducing mortality in a cohort of tuberculosis (TB) patients registered under routine programme conditions in a rural district of Malawi. DESIGN: 'Before' and 'after' cohort study using historical controls. METHODS: Between 1 July 1999 and 30 June 2000 all TB patients were started on standardized anti-TB treatment, and offered voluntary counselling and HIV testing (VCT). Those found to be HIV-positive were offered cotrimoxazole at a dose of 480 mg twice daily, provided there were no contraindications. Side-effects were monitored clinically. End-of-treatment outcomes in this cohort (intervention group) were compared with a cohort registered between 1 July 1998 and 30 June 1999 in whom VCT and cotrimoxazole was not offered (control group). FINDINGS: A total of 1986 patients was registered in the study: 1061 in the intervention group and 925 in the control cohort. In the intervention group, 1019 (96%) patients were counselled pre-test, 964 (91%) underwent HIV testing and 938 (88%) were counselled post-test. The overall HIV-seroprevalence rate was 77%. A total of 693 patients were given cotrimoxazole of whom 14 (2%) manifested minor dermatological reactions. The adjusted relative risk of death in the intervention group compared with the control group was 0.81 (P < 0.001). The number needed to treat with VCT and adjunctive cotrimoxazole to prevent one death during anti-TB treatment was 12.5. INTERPRETATION: This study shows that VCT and adjunctive cotrimoxazole is feasible, safe and reduces mortality rates in TB patients under routine programme conditions.en
dc.language.isoenen
dc.rightsPublished by Wolters Kluwer Lippincott Williams & Wilkins - Archived on this site by kind permission Wolters Kluweren
dc.subject.meshAIDS-Related Opportunistic Infectionsen
dc.subject.meshAdolescenten
dc.subject.meshAdulten
dc.subject.meshAgeden
dc.subject.meshAnti-Infective Agentsen
dc.subject.meshChemotherapy, Adjuvanten
dc.subject.meshChilden
dc.subject.meshChild, Preschoolen
dc.subject.meshCohort Studiesen
dc.subject.meshCounselingen
dc.subject.meshFeasibility Studiesen
dc.subject.meshFemaleen
dc.subject.meshFollow-Up Studiesen
dc.subject.meshHIV Infectionsen
dc.subject.meshHIV Seropositivityen
dc.subject.meshHumansen
dc.subject.meshInfanten
dc.subject.meshMalawien
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshPatient Complianceen
dc.subject.meshProportional Hazards Modelsen
dc.subject.meshRural Healthen
dc.subject.meshSelf Administrationen
dc.subject.meshSurvival Analysisen
dc.subject.meshTreatment Outcomeen
dc.subject.meshTrimethoprim-Sulfamethoxazole Combinationen
dc.subject.meshTuberculosisen
dc.subject.meshVoluntary Programsen
dc.titleVoluntary Counselling, HIV Testing and Adjunctive Cotrimoxazole Reduces Mortality in Tuberculosis Patients in Thyolo, Malawi.en
dc.contributor.departmentMedecins Sans Frontieres-Luxembourg, Blantyre, Malawi. zachariah@internet.Luen
dc.identifier.journalAIDS (London, England)en

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