High Tuberculosis and HIV Coinfection Rate, Johannesburg

To the Editor: Tuberculosis (TB) is the leading cause of illness and death among HIV-1–infected patients in sub-Saharan Africa (1–3), but valid data on the population-level interaction between the TB and HIV epidemics are scarce (4). Our objective was to determine the extent of this dual epidemic in our setting, a hospital in Johannesburg, South Africa. We did this by introducing bedside TB and HIV counseling. We also intended to increase the use of voluntary counseling and testing for our TB patients and facilitate referral to our antiretroviral clinic. volunteers from Community AIDS Response (CARE) counseled patients admitted to the medical wards of the Helen Joseph Hospital. This regional hospital serves a catchment population of >500,000 people, predominantly low-income black Africans. Counselors provided TB and HIV well-ness and adherence information, HIV pretest counseling, and referral to the Themba Lethu Clinic for rapid testing that used standard CARE modules. Basic demographic, TB, and HIV data from patient records were documented on standard data collection forms. Missing data were extracted from the hospital database and Therapy Edge-HIV, the data management system used by the HIV clinic. HIV testing was conducted with a fourth-generation ELISA or rapid fi nger prick antibody test, according to World Health Organization guidelines. Most admissions were for pulmonary TB. A total of 467 patients receiving TB treatment were counseled; 8 of these patients refused the TB counseling service, and 2 refused voluntary counseling and testing for HIV. These 467 patients constituted 13% of medical admissions and excluded the 1,075 patients seen at the hospital's outpatient clinic with suspected TB for this 3-month period. Our impression is that this fi gure constitutes an under-representation of the total TB admissions because TB counselors were not able to see every patient with TB. Laboratory data were retrievable for 373 inpatients. For 301 (81%) of the 373 patients, TB blood culture, smear, or culture results could be traced. Hence, 72 (19%) of 373 patients who were receiving TB treatment had no record of a diagnostic effort to confi rm TB. A total of 284 (76%) HIV test results could be traced; 270 (95%) of the 284 accessible TB patients had concurrent HIV infection (Table). Most (123 [89%]) documented HIV results were from ELISAs performed during admission. Rapid testing performed in the ward was unacceptable to patients because con-fi dentiality was compromised in large, busy wards and patients were often too ill to …