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Prevalence of HIV Infection and Risk Factors of Tuberculin Skin Test Results among Household Contacts in a HIV Epidemic Area: Chiang Rai
Province, Thailand
byPornnapa Suggaravetsiri, Ph.D.(Epidemiology)
Faculty of Public Health, Khon Kaen University, ThailandJuthatip Putthasorn, M.D.
Chiang Rai Prachanukraow Hospital, Thailand
Rationale of the study
• Both HIV/AIDS and TB are increasing in Thailand especially in the Northern region
•TB sharply increased in Chiang Rai Province
• Knowledge on the extent to which HIV+TB contributes to the transmission of the disease will be useful for further planning for intervention
Objectives1. To determine prevalence of HIV and
TB Infection among household contacts of new TB sputum positive cases
2. To identify risk factors of tuberculosis infection among household contacts of new TB sputum positive cases
Thailand
Chiang-Chiang-RaiRai
MUANG ( 154 )
Area : 11,678 Km2
MAECHAN ( 381 )
MAE SAI ( 229 )
Phan Mae Lao
WiengChai
Setting
Study design
• Cross-sectional study• The study was carried out from
June 2000 and January 2002
Collecting DataFor data collection the
following tools had been used:•Structured interviews•Physical examination•Tuberculin skin test (TST) and
Mumps skin test •Pre-test and post-test
counseling for HIV testing
Inclusion criteria
Index TB cases• Newly TB cases• AFB smear+ • > 15 years old and known HIV status• willing to participant in this project
Household contacts• Stay in the same house with index case > 4 days/week & > 4 weeks before initial TST • Willing to participate and had singed consent to participate
Exclusion Criteria
• Index cases or contacts not willing to participate• Living outside of the study area• Index cases being prisoner• Home visit not possible because of various reasons• Index’s HIV status unknown
Sample Size
•1,211 household contacts participated in this study
TST
Measurement of TB infectionby using tuberculin skin test (TST)
Mumps skin test
TST MST
Data Processing & analysis
• Statistical analysis using STATA v 8.2
• Main results:– prevalence of TST+ using cut-off point of induratio
n size ( >10 mm.)
– Univariate analysis of TST + and each independent variable by OR and 95% CI
– Multivariate analysis and adjustment for confounder
Participate
526 TB cases
Pool of TB index cases 530 cases
Participate and TST1211 contacts
Participation of subjects
Participate and TST1240 contacts – 29 anergy skin test
Prevalence of HIV +ve among household contacts
7.74% (72 / 930 of contacts who did agree for HIV testing)
Results
Prevalence of TST +ve among household contacts
56.98% (690 / 1211 of contacts who did agree for TST)
Table 1 Rate and OR of TST positive and characteristics of household
contactsCharacteristic Number and Prevalence
(%) of TST-positive
Crude OR 95% CI p-value
SexSex
Male 327/528 (61.93) 1.00
Female 363/683 (53.15) 0.51 0.40-0.65 <0.01
Age (years)Age (years)
<10 75/239 (31.38) 1.00
10-19 111/189 (58.73) 3.11 2.09-4.63 <0.01
20-29 107/146 (73.29) 6.00 3.80-9.48 <0.01
30-39 119/171 (69.59) 5.00 3.27-7.66 <0.01
40-49 103/148 (69.59) 5.01 3.21-7.80 <0.01
50-59 82/124 (66.13) 4.27 2.69-6.77 <0.01
≥ 60 93/194 (47.94) 2.01 1.36-2.98 <0.01
Table 1 Rate and OR of TST positive and characteristics of household
contacts (cont.)Characteristic Number and Prevalence (%)
of TST-positiveCrude OR 95% CI p-value
Race / EthnicityRace / Ethnicity
Thai 639/1126 (56.75) 1.00
Hill tribe 51/ 85 (60.00) 1.14 0.73-1.79 0.56
Marital statusMarital status
Single 244/508 (48.03) 1.00
Married 358/558 (64.16) 1.94 1.52-2.48 <0.01
Divorced 88/145 (60.69) 1.67 1.15-2.43 <0.01
Relationship to Index caseRelationship to Index case
Relative 179/366 (48.91) 1.00
Spouse 203/282 (71.99) 2.68 1.93-3.74 <0.01
Children 121/238 (50.84) 1.08 0.78-1.50 0.64
Parent 187/325 (57.54) 1.42 1.05-1.91 0.02
Table 2 Univariate analysis of risk factors associated with TB
infectious among household contacts Variable TST+ TST - OR 95 % CI p-value
Alcohol drinking
No 577 478 1.00
Yes 113 43 2.18 1.50-3.16 <0.01
Cigarette smoking
No 449 380 1.00
Yes 241 141 1.45 1.13-1.85 <0.01
BCG scar present
Positive 411 274 1.00
Negative 279 247 0.75 0.60-0.95 <0.01
HIV status
Positive 22 20 1.00
Negative 539 316 1.55 0.83-2.87 0.17
Table 2 Univariate analysis of risk factors associated with TB
infectious among household contacts (cont.)
Variable TST + TST - OR 95 % CI p-value
Care giver to the TB patient
No 376 406 1.00
Yes 314 115 2.95 2.83-3.81 <0.01
Sleeping in the same bedroom as the TB patient
No 379 362 1.00
Yes 311 159 1.87 1.47-2.37 <0.01
Sleeping in the same bed as the TB patient
No 448 395 1.00
Yes 242 126 1.69 1.31-2.18 <0.01
Table 3 Multivariate analysis of risk factors associated with TB infectious
among hhcVariable in model Adj.OR (95 % CI) p-value
Sex
Male 1.00
Female 0.45 (0.33-0.61) <0.01
Age (years)
<10 1.00
10-19 3.70 (1.89-7.25) <0.01
20-29 6.45 (3.21-12.96) <0.01
30-39 5.34 (2.70-10.57) <0.01
40-49 5.55 (2.79-11.05) <0.01
50-59 6.26 (2.99-12.87) <0.01
≥ 60 2.56 (1.29-5.08) <0.01
Variables entered in the Multiple Logistic Regression Analysis were sex, age, BCG scar present, HIV status, Care giver to the TB patient, and Sleeping in the same bedroom as the TB patient
Table 3 Multivariate analysis of risk factors associated with TB infectious among household contacts (cont)
Variable in model Adj.OR (95 % CI) p-value
BCG scar present
Positive 1.00
Negative 0.74 (0.53-1.04) 0.08
HIV status
Positive 1.00
Negative 3.15 (1.57-6.33) <0.01
Care giver to the TB patient
No 1.00
Yes 2.04 (1.48-2.81) <0.01
Sleeping in the same bedroom as the TB patient
No 1.00
Yes 1.99 (1.44-2.74) <0.01
Conclusion and Suggestions
The results of this study suggest that:• High prevalence of HIV and TB among
HHC
• Screening every 6 months should be provided to TB pt. household members
• To TB pt. VCT should be provided
• To HIV+ anti-TB prophylaxis and treatment should be provided
• Prevention HIV will be decrease TB
Thanks for your attention
Acknowledgement : Staff of TB/HIV Research Project, particularity Sunee,
Saiyood, Mitree, Ratikorn,Uthumporn, Dollaporn and Piyanoot for collection, validation and management.
Doctors and staff of TB clinic and Micro- laboratory, TB patients and Their households of CHR, MH and Phan Hospital
Thailand-Tropical Diseases Research Programme (T-2) and TB/HIV Research Project, Research Institute of Tuberculosis (RIT), Japan for financial supported this study.
Professor Dr. med. Frank Peter Schelp to edit manuscript
Correspondence: [email protected]