Voluntary counselling, HIV testing and adjunctive cotrimoxazole reduces mortality in tuberculosis patients in Thyolo, Malawi.
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.
| Item Type | Article |
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| Keywords | AIDS-Related Opportunistic Infections, Adolescent, Adult, Aged, Anti-Infective Agents, Chemotherapy, Adjuvant, Child, Child, Preschool, Cohort Studies, Counseling, Feasibility Studies, Female, Follow-Up Studies, HIV Infections, HIV Seropositivity, Humans, Infant, Malawi, Male, Middle Aged, Patient Compliance, Proportional Hazards Models, Rural Health, Self Administration, Survival Analysis, Treatment Outcome, Trimethoprim-Sulfamethoxazole Combination, Tuberculosis, Voluntary Programs, AIDS-Related Opportunistic Infections, complications, drug therapy, Adolescent, Adult, Aged, Anti-Infective Agents, therapeutic use, Chemotherapy, Adjuvant, Child, Child, Preschool, Cohort Studies, Counseling, Feasibility Studies, Female, Follow-Up Studies, HIV Infections, diagnosis, HIV Seropositivity, Humans, Infant, Malawi, Male, Middle Aged, Patient Compliance, Proportional Hazards Models, Rural Health, Self Administration, Survival Analysis, Treatment Outcome, Trimethoprim-Sulfamethoxazole Combination, therapeutic use, Tuberculosis, complications, drug therapy, mortality, Voluntary Programs |
| ISI | 182834600015 |