L.R slides on the prevalenceofPTBde.pptx

A literature review on the prevalence of PTB

1. Chapter 2; LITERATURE REVIEW

2. HIV/PTB co-infection is a significant burden in K enya Understanding the prevalence, diagnostic methods available and treatment outcomes is crucial for; Inform public health strategies Treatment approaches Resource allocation

3. Prevalence Globally, approximately 30% of HIV- coinfected have PTB(WHO 2012) A total of 8.7m cases in 2011 with 24% in A frica Kenya accounts for 79% of all the cases in sub-saharan Africa Kenya ranks 13/22 countries with the high burden In K enya, the positivity rate was 25.2% in 2020 a drop from 26% in 2019(MOH,TB annual report)

4. Kenyan studies.. A study on burden of HIV and treatment outcomes among TB patients in rural kenya A 9year longitudinal study by moses ngari et al..in nyeri and kilifi counties between 2012-2020 Results; 27,285 patients 64%m,36%f 23986(86%)- new TB cases and 91% started on RHZE Kilifi - prevalence was 30% in 2012, 25% in 2020 Nyeri - prevalence 35% in 2012, 22% in 2020 Overall, prevalence was 32% in 2012, plateauing btn 2012-2014, declined to 24% in 2020

5. Cont.. A survey on TB and HIV at national level kenya AIDS survey 2014 by agneta mbithi et al.. It was a national population based household survey from oct 2012- feb 2013, a cross sectional study Information collected via household questionnaires in 13,720 persons Results; 13,720 persons aged 15-64 yrs participated Positivity rate was 33.2% compared to 5.1% without TB

6. Diagnostic methods.. Patients with HIV/TB coinfection have a lower immunity, lower bacterial load in sputum Clinical and imaging manifestations are atpical Conventional methods like sputum smear for microscopy, gene xpert , culture, tuberculin skin tests, IFN-Y assay are low LAM can be done, low cost and point of care assay Lateral flow(LF-LAM) has higher sensitivity

7. Studies.. An autopsy study in S.africa in 2015, a prospective descriptive study of HIV patients who died without TB deteection 45.8% of HIV coinfected pts fail to diagnose TB before death Pts with subclinical TB, smear- neg TB, MDR are difficult to diagnose & may be missed Results; 125 patients 101- HIV positive 78- 62% had TB 66- 85% had HIV/TB coinfection Of note; 20 of 78 pts with TB were not diagnosed during their life Interpretation; need for more clinical awareness & more proactive screening

8. Studies… A study on screening & testing for TB among HIV coinfected in Western kenya by philip owiti et al. A retrospective study btn 2015-2016 Results; 683,898 encounters 87% screening for TB recorded 90,454 PLWH 1424(1.6%) were not screened at all Overall; In 8% of the symptomatic, sputum microscopy,CXR recorded 92% did not have TB-related lab results recorded Most misses opportunities for screening & testing for TB

9. Treatment outcomes.. All hiv positive pts shd be screened for TB and meds started if have the disease Regimen similar to hiv-neg pts , dose adjustment Rifampin may be replaced by rifabutin to avoid drug reactions Caution on IRIS due to stronger immune response Preventive therapy include isoniazid,rifampin

10. Studies.. The same study by moses ngari et al.. A 9 yr longitudinal study btn 2012-2020 in kilifi and nyeri counties Results; 22,994 pts (84%) completed 6months 2084(7.6%) deaths 1179(4.3%) lost to follow up HIV was ass with lower odds of completing TB rx , moredeaths compared with HIV neg pts