ViewpointDeaths from tuberculosis in sub-Saharan African countries with a high prevalence of HIV-1
Section snippets
Why do HIV-positive tuberculosis patients die in sub-Saharan Africa?
HIV-positive patients have much higher death rates during the time they are being treated for tuberculosis than patients without HIV.3 In sub-Saharan Africa, about 30% of HIV-positive patients die within 12 months of treatment. HIV-positive patients with smear-negative pulmonary tuberculosis (possibly because of more severe immunosuppression and diagnostic difficulties) fare even worse.4 What are the reasons for these high death rates? There are the wide social, cultural, and economic issues of
The response so far to the threat posed by HIV
Some countries have mounted information, education, and communication campaigns for the general public and front-line health workers about the need for early submission of sputum samples for patients with a chronic cough. However, there is little evidence that this has had any effect in reducing diagnostic delays.7 Algorithms are in place for the diagnosis of smear-positive pulmonary tuberculosis that incorporate chest symptoms, lack of response to antibiotics, negative sputum smears, and chest
Research needed to reduce mortality in HIV-related tuberculosis
Further work is needed to enable a coordinated, multidisciplinary approach to reduce mortality. We suggest that the following objectives should be the focus of a research effort aimed at quickly enabling tuberculosis control programmes to reduce death rates in HIV-positive patients with tuberculosis in sub-Saharan Africa panel.
Conclusion
We appreciate that the size of the problem that we are addressing is enormous, and there is a temptation to conclude that nothing can be done. We also recognise that our research focus is narrow and based on what we, as practitioners involved in tuberculosis control programmes, perceive to be some of the factors responsible for the deaths of so many of our patients. The research we suggest is relevant to the needs and resources of tuberculosis control programmes and health ministries, and, to a
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