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TB Notes 3, 2007
Director's Letter
Highlights from State and Local Programs
  Georgia Statewide TB Training
NTCA Workshop Poster Contest
2007 EIS Conference a Success for DTBE
National Tuberculosis Indicators Project (NTIP): An Update
Evaluation Team Visits TB Isolation Village in Thailand
TB Education and Training Network Updates
  Member Highlight
  Cultural Competency Subcommittee Update
Communications, Education, and Behavioral Studies Branch Update
  A Review of DTBE’s First Year Using the CDC INFO Call Center
Surveillance, Epidemiology, and Outbreak Investigations Branch Updates
  TB/HIV Surveillance in Ethiopia
TB Epidemiologic Studies Consortium Updates
  2007 World TB Day: TBESC Sites Across the U.S. Get Involved
  “The First Global Symposium on Interferon-Gamma Assays” 2007
New CDC Publications
Personnel Notes
Calendar of Events
 
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TB Notes Newsletter

No. 3, 2007

SURVEILLANCE, EPIDEMIOLOGY, AND OUTBREAK INVESTIGATIONS BRANCH UPDATE

TB/HIV Surveillance in Ethiopia

Did you know that Ethiopia has “13 months of sunshine”? It’s true! The Ethiopian calendar has 12 months of 30 days each, plus an additional 13th month with 5 or 6 days. Currently in Ethiopia it is 1999, and they will celebrate the millennium year (2000) this September.

Imagine reviewing TB registers in an Ethiopian hospital, trying to remember that March 2007 is actually written as 7/1999 in the records! This provided an interesting challenge to me during my site visit from March 26 to April 13 while I was working on a project for DTBE’s International Research and Programs Branch.

The purpose of my trip was to assess TB/HIV recording procedures in hospitals and to work with the local partners to determine ways to improve recording of TB/HIV data. I visited eight hospitals and one health center. Half of the sites were in the capital city, Addis Ababa, and the others were in different regions of the country.

Data collected

I reviewed the registers in the TB clinic and in the antiretroviral therapy (ART) clinic at each site and attempted to collect data on the number of--

  • Persons diagnosed with TB;
  • TB patients who were offered HIV testing;
  • TB patients who received HIV testing;
  • TB patients who were HIV infected;
  • TB/HIV patients receiving ART; and
  • TB/HIV patients receiving cotrimoxizole preventive treatment (CPT) to prevent pneumonia.

Results

We were mostly interested in determining the percentage of TB patients who were tested for HIV, since, as you may know, TB is the number one killer of persons with HIV worldwide. In summary, for January 2006–March 2007, I found the following average data for the nine sites:

  • 45% of TB patients were tested for HIV (range: 31%–84%)
  • 36% of TB patients were infected with HIV (range: 14%–65%)
  • 49% of TB/HIV patients started on CPT (range: 15%–97%)
  • 65% of TB/HIV patients started on ART (range: 16%–100%)

Many of these percentages are likely underestimates owing to incomplete recording. Following are some of the barriers I faced while trying to collect the data:

  • The TB register provided by the Ministry of Health (MOH) does not include a place for HIV information
  • TB information is not recorded in the ART register at many sites, even though there is a column for TB treatment in the ART register
  • Multiple registers are used at some sites

The photo shows a coworker reviewing TB/HIV registry books at Shashemene HospitalThe photo shows a coworker reviewing TB/HIV registry books at Shashemene Hospital, and two nurses behind him, very happy to put on “I have TB (resources)!” buttons.

Recommendations

Based on my individual site visits and analysis of the data, I recommended that an updated TB register be distributed as soon as possible by the MOH, and that on-site training be provided to hospital staff to emphasize the importance of accurate recording of TB/HIV data and to explain how to complete the registers.

At the end of the day, the main goals are to increase the number of TB patients tested for HIV and increase the number of TB/HIV patients who are started on CPT and ART, ultimately improving the health and quality of life for TB patients.

—Reported by Lauren Lambert, MPH
Division of TB Elimination

 


Released October 2008
Centers for Disease Control and Prevention
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