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Free Content Prevalent infectious tuberculosis in Harare, Zimbabwe: burden, risk factors and implications for control

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SETTING: Harare's high density suburbs.

OBJECTIVES: To investigate the burden, duration and risk factors for prevalent tuberculosis (TB) and explore potential control strategies.

METHODS: Randomly selected adults had TB culture, symptom screen and human immunodeficiency virus (HIV) serology. Prevalent TB was defined as undiagnosed or still culture-positive. Notification data and HIV prevalence in TB out-patients were used to estimate duration of infectiousness (prevalence/estimated incidence).

RESULTS: Among 10 092 participants, 40 (0.40%, 95%CI 0.28–0.54) had prevalent smear-positive TB. HIV (adjusted odds ratio [aOR] 3.1, 95%CI 1.6–6.3, population attributable fraction [PAF] 33%), male sex (aOR 3.1, 95%CI 1.5–6.4, PAF 40%), and overcrowding (PAF 34%) were significant risk factors, with past TB treatment significant for HIV-negative participants only (PAF 7%). Recent household TB contact was not significant (PAF 10%). HIV prevalence was 21.1%; 76.9% of HIV-positive participants were previously untested. Duration of infectiousness was at least 18 weeks in HIV-positive and approximately 1 year in HIV-negative patients.

CONCLUSIONS: Overcrowding, male sex and HIV infection were major risk factors for prevalent smear-positive TB. Reducing diagnostic delay may have greater potential to improve the control of prevalent TB than interventions targeted at household contacts, TB treatment outcomes, or TB-HIV interventions under current levels of awareness of HIV status.
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Keywords: Africa; HIV; prevalence study; risk factors; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Clinical Research Unit, London School of Hygiene & Tropical Medicine (LSHTM), London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe 2: Biomedical Research and Training Institute, Harare, Zimbabwe 3: Infectious Disease Epidemiology Unit, LSHTM, London, UK 4: Biomedical Research and Training Institute, Harare, Zimbabwe; and National Institute of Health Research, Harare, Zimbabwe 5: Aurum Institute, Johannesburg, South Africa 6: Stop TB Department, World Health Organization, Geneva, Switzerland 7: Clinical Research Unit, London School of Hygiene & Tropical Medicine (LSHTM), London, UK; and Biomedical Research and Training Institute, Harare, Zimbabwe 8: Harare City Health, Harare, Zimbabwe 9: Biomedical Research and Training Institute, Harare, Zimbabwe; and University of Zimbabwe Medical School, Harare, Zimbabwe

Publication date: 2009-10-01

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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