Prevalence of tuberculosis, HIV and respiratory symptoms in two Zambian communities: Implications for tuberculosis control in the era of HIV

Ayles, Helen
Schaap, Albertus
Nota, Amos
Sismanidis, Charalambos
Tembwe, Ruth
De Haas, Petra
Muyoyeta, Monde
Beyers, Nulda
Godfrey-Faussett, Peter
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Public Library of Science (PLOS)
Background: The Stop TB Partnership target for tuberculosis is to have reduced the prevalence of tuberculosis by 50% comparing 2015 to 1990. This target is challenging as few prevalence surveys have been conducted, especially in high burden tuberculosis and HIV countries. Current tuberculosis control strategies in high HIV prevalent settings are therefore based on limited epidemiological evidence and more evidence is needed from community-based surveys to inform improved policy formulation. Methods and Findings: 8044 adults were sampled from 2 sub-districts (wards) in Lusaka province, Zambia. Questionnaires were used to screen for symptoms, respiratory samples were obtained for culture and oral secretions collected for HIV testing. 79 individuals were found to have Mycobacterium tuberculosis in their sputum, giving an adjusted overall prevalence of tuberculosis of 870/100,000 (95% CI 570-1160/100,000). The adjusted overall prevalence of HIV was 28.61% (95% CI 26.04-31.19). HIV- infection was significantly associated with prevalent tuberculosis (Adj OR 2.3, 95% CI 1.42-3.74) and the population attributable fraction of HIV for prevalent tuberculosis was 36%. Symptoms such as prolonged cough (adj OR 12.72, 95% CI 7.05-22.94) and fever (Adj OR 2.04, 95%CI 1.23-3.39), were associated with prevalent tuberculosis, but 8 (10%) individuals with prevalent tuberculosis denied having any symptoms at all and only 34 (43%) would have been classified as a TB suspect by current guidelines. Conclusions: Undiagnosed tuberculosis is a challenge for tuberculosis control and new approaches are needed if we are to reach international targets. Epidemiological studies can inform screening algorithms for both detection and prevention of active tuberculosis. © 2009 Ayles et al.
The original publication is available at http:/
Human immunodeficiency virus infection, Mycobacterium tuberculosis -- Diagnosis, Tuberculosis control -- South Africa, Tuberculosis control -- Zambia, Tuberculosis and HIV -- Zambia -- Case study, Tuberculosis and HIV -- South Africa -- Case studies, HIV infections -- Transmission -- Zambia, Tuberculosis -- Transmission -- South Africa
Ayles, H. et al. 2009. Prevalence of Tuberculosis, HIV and Respiratory Symptoms in Two Zambian Communities: Implications for Tuberculosis Control in the Era of HIV. PLoS ONE, 4(5): e5602, doi:10.1371/journal.pone.0005602.