HIV and tuberculosis in a rural hospital in Kenya

Abstract

Objective: To document the incidence and prevalence of HIV infection and TB in patients attending a rural Kenyan hospital. Design: A retrospective analysis of newly diagnosed HIV and TB-infected patients, HIV and TB-related admissions, and results of blood donor screening for HIV from 1993 to 1997. Setting: PCEA Chogoria Hospital, Eastern Province, Kenya. Subjects: Patients diagnosed with HIV infection and/or TB; all blood donors. Intervention: Diagnosis of pulmonary TB by Ziehl-Neelsen staining of sputum smears; diagnosis of smear negative and extrapulmonary TB based on consistent clinical and radiological features; HIV-1 and HIV-2 testing of patients clinically suspected to be infected and all blood donors. Main outcome measures: Patients diagnosed with HIV and/or TB from 1993 to 1997; the number of HIV and TB related admissions and the associated mortality rates. Results: A rising incidence of newly diagnosed HIV patients is documented, and an increasing number of TB patients are co-infected with HIV. The number of HIV inpatient episodes is increasing, against a background of falling inpatient and outpatient episodes. HIV seroprevalence among blood donors is stable at 3-4%. The proportion of TB patients suffering from extrapulmonary TB is increasing (p=0.011), probably as a result of the increase in HIV. Conclusion: The HIV epidemic is having an increasing impact on rural Kenyans' health, although background seroprevalence rates are apparently stable. TB patients co-infected with HIV are placing a growing burden on health care resources. All health care facilities face a challenge as to how best to use limited resources to combat both these deadly diseases.