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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Voluntary counselling, HIV testing and adjunctive cotrimoxazole reduces mortality in tuberculosis patients in Thyolo, Malawi
AIDS, Volume 17, No. 7, Year 2003
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Description
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. © 2003 Lippincott Williams & Wilkins.
Authors & Co-Authors
Zachariah, Rony R.Z.
Switzerland, Geneva
Medecins Sans Frontieres
Spielmann, Marie Paule L.
Switzerland, Geneva
Medecins Sans Frontieres
Chinji, C.
Malawi, Lilongwe
Ministry of Health Malawai
Gomani, Patrick
Malawi
Malamulo Mission Hospital
Arendt, Vic
Unknown Affiliation
Hargreaves, Nicola J.
Unknown Affiliation
Salaniponi, Felix M.L.
Unknown Affiliation
Harries, Anthony David
Unknown Affiliation
Statistics
Citations: 116
Authors: 8
Affiliations: 3
Identifiers
Doi:
10.1097/00002030-200305020-00015
Research Areas
Infectious Diseases
Study Design
Randomised Control Trial
Cohort Study
Study Approach
Quantitative
Study Locations
Malawi