Tuberculosis among clients attending HIV voluntary counseling and testing centres in Dar es salaam

Background: There is an increase in Tuberculosis (TB) among HIV infected individuals and these pose and increased risk of TB transmission. The diagnosis of TB among these individuals' remains a challenge especially in developing countries. Despite the dose epidemiological links between TB and HIV the public health responses have been largely separate. Objectives: To determine the prevalence of TB and develop a means of diagnosis of tuberculosis among HIV infected without using undue laboratory investigations among VCT clients. Study setting: Two VCT centres located in Dar-es-salaam. Study design and subjects: A cross-sectional study of 1318 consecutive clients aged 8years and above attending the selected VCTs between 1st November 2002 and 31th January 2003. Methods: Clinical evaluation was performed to all study subjects. Sputum was sent for Acid alcohol fast bacilli staining (AAFB), culture and sensitivity for Mycobacterium tuberculosis. Aspirates and biopsies were performed from appropriate sites from patients with pleural effusion, ascites and palpable peripheral lymph nodes. The specimens were sent for AAFB staining, culture and histology. Results: The overall TB prevalence was 101(7.7%), of these 38(2.9%) TB diagnosis was made before reporting to the VCT and these came only for HIV screening, while 63(4.92%) of the remaining 1280 were subsequently diagnosed to have active tuberculosis. Pulmonary TB was the more prevalent form of disease 82.5% (52/63) compared to the Extra pulmonary TB that was diagnosed in 15.9% (10/63), p<0.0001. One subject (1.6%) had both pulmonary and extra-pulmonary tuberculosis. Overall HIV prevalence was 26.3 % (347/1318).20.2% (70/347) had concomitant tuberculosis. Following multivariate analysis, factors that could differentiate tuberculosis from those without tuberculosis among HIV infected individuals were night sweats, Cough, lymphadenopathy, previous history of TB, matted lymph nodes, hair changes, crackles, consolidation and pleural effusion. These factors could correctly classify (85.9%) of the HIV infected individuals into those with tuberculosis and no tuberculosis, and a simple clinical algorithm is proposed. None of the M. Tuberculosis isolates was found to be resistant to the tested anti-TB drugs. Conclusion: It is recommended that TB screening at VCTs be aggressively pursued to allow early diagnosis, prevention of transmission, early institution of anti-TB treatment, and provision of prophylaxis against tuberculosis among HIV infected individuals excluded to have active tuberculosis.