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  • Title: The increasing burden of tuberculosis in rural South Africa--impact of the HIV epidemic.
    Author: Wilkinson D, Davies GR.
    Journal: S Afr Med J; 1997 Apr; 87(4):447-50. PubMed ID: 9254788.
    Abstract:
    OBJECTIVE: To determine the impact of the HIV epidemic on tuberculosis caseload in rural South Africa. SETTING: Hlabisa health district, KwaZulu-Natal. METHODS: Demographic and clinical data were extracted from the tuberculosis database for the period, May 1991-June 1995. The attributable fraction of HIV-infected tuberculosis cases was estimated from the prevalence of HIV infection in tuberculosis cases and the prevalence of HIV infection in women attending antenatal clinics. RESULTS: Between 1991 and 1995, the annual tuberculosis caseload increased from 301 to 839 cases. Tuberculosis accounted for 4.7% of all admissions in 1989 and 8.3% in 1995 (P < 0.0001). The incidence of tuberculosis increased from 154/100,000 in 1991, to 413/100,000 in 1995. The proportion with smear-positive pulmonary disease fell from 65% to 56% (P = 0.04), and pleural tuberculosis accounted for 7.5% of disease in 1991 and 18% in 1995 (P = 0.002). The minimum HIV prevalence in patients with tuberculosis increased from 8.7% in 1991 to 28.3% in 1995, and the proportion of tuberculosis cases attributable to HIV infection was estimated to be at least 44% in 1995. CONCLUSION: The burden of HIV-related tuberculosis is increasing rapidly in rural South Africa and is exerting a negative impact. Innovative approaches to control will be needed to cope with it effectively.
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