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The burden and treatment of HIV in tuberculosis patients in Papua Province, Indonesia: a prospective observational study

Pontororing, Gysje J., Kenangalem, Enny, Lolong, Dina B., Waramori, Govert, Sandjaja, Tjitra, Emiliana, Price, Ric N., Kelly, Paul M., Anstey, Nicholas M. and Ralph, Anna P. (2010). The burden and treatment of HIV in tuberculosis patients in Papua Province, Indonesia: a prospective observational study. BMC Infectious Diseases,10:362-370.

Document type: Journal Article
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IRMA ID 81704288xPUB261
Title The burden and treatment of HIV in tuberculosis patients in Papua Province, Indonesia: a prospective observational study
Author Pontororing, Gysje J.
Kenangalem, Enny
Lolong, Dina B.
Waramori, Govert
Sandjaja
Tjitra, Emiliana
Price, Ric N.
Kelly, Paul M.
Anstey, Nicholas M.
Ralph, Anna P.
Journal Name BMC Infectious Diseases
Publication Date 2010
Volume Number 10
ISSN 1471-2334   (check CDU catalogue open catalogue search in new window)
Start Page 362
End Page 370
Total Pages 9
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
Abstract Background
New diagnoses of tuberculosis (TB) present important opportunities to detect and treat HIV. Rates of HIV and TB in Indonesia's easternmost Papua Province exceed national figures, but data on co-infection rates and outcomes are lacking. We aimed to measure TB-HIV co-infection rates, examine longitudinal trends, compare management with World Health Organisation (WHO) recommendations, and document progress and outcome.

Methods
Adults with newly-diagnosed smear-positive pulmonary TB managed at the Timika TB clinic, Papua Province, were offered voluntary counselling and testing for HIV in accordance with Indonesian National Guidelines, using a point-of-care antibody test. Positive tests were confirmed with 2 further rapid tests. Study participants were assessed using clinical, bacteriological, functional and radiological measures and followed up for 6 months.

Results
Of 162 participants, HIV status was determined in 138 (85.2%), of whom 18 (13.0%) were HIV+. Indigenous Papuans were significantly more likely to be HIV+ than Non-Papuans (Odds Ratio [OR] 4.42, 95% confidence interval [CI] 1.38-14.23). HIV prevalence among people with TB was significantly higher than during a 2003-4 survey at the same TB clinic, and substantially higher than the Indonesian national estimate of 3%. Compared with HIV- study participants, those with TB-HIV co-infection had significantly lower exercise tolerance (median difference in 6-minute walk test: 25 m, p = 0.04), haemoglobin (mean difference: 1.3 g/dL, p = 0.002), and likelihood of cavitary disease (OR 0.35, 95% CI 0.12-1.01), and increased occurrence of pleural effusion (OR 3.60, 95% CI 1.70-7.58), higher rates of hospitalisation or death (OR 11.80, 95% CI 1.82-76.43), but no difference in the likelihood of successful 6-month treatment outcome. Adherence to WHO guidelines was limited by the absence of integration of TB and HIV services, specifically, with no on-site ART prescriber available. Only six people had CD4+ T-cell counts recorded, 11 were prescribed co-trimoxazole and 4 received ART before, during or after TB treatment, despite ART being indicated in 14 according to 2006 WHO guidelines.

Conclusions

TB-HIV co-infection in southern Papua, Indonesia, is a serious emerging problem especially among the Indigenous population, and has risen rapidly in the last 5 years. Major efforts are required to incorporate new WHO recommendations on TB-HIV management into national guidelines, and support their implementation in community settings.

Keywords HIV
tuberculosis (TB)
Papua Province, Indonesia
DOI http://dx.doi.org/10.1186/1471-2334-10-362   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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Created: Thu, 11 Oct 2012, 10:57:16 CST by Teresa Haendel