Tuberculosis Cases and Treatment Outcomes in a HIV Cohort on an HIV program in Cambodia

Author: Prahors Ung

Abstract

There is very limited documented information on the occurrence of TB and outcome of treatment among TB/HIV co-infected adults patients enrolled within HIV programs in resource-limited settings. A detailed analysis in the Cambodian setting will bring better understanding in this context where little other data exists.

A retrospective cohort study of routine data from the Chronic Disease Clinic in Donkeo Referral Hospital of Takeo province which was carried out by MSF B from 2003 to 2008. It comprised 3320 HIV adults’ patients receiving free care for a 66 month period.

The outcomes of TB treatment in this HIV cohort were assessed. In total there were 1114 TB cases detected out of 3320 HIV positive patients (30%). Out of these, 239 cases (21.45%) were smear positive pulmonary tuberculosis, and of which 338 (30.34%) cases were smear negative pulmonary tuberculosis. 93.8% were new cases. The most predominant type of Extra-Pulmonary Tuberculosis (EPTB) among HIV positive patients was the infection of the lymph nodes which was 252 cases ( 54.9%), followed by 123 cases of digestive tract EPTB (26.8%). Among 1114 TB cases, 59.7% were treatment completed 7.2% were cured and 15.8% died. There was a high death rate among HIV/TB co-infected new Positive Sputum Smear Pulmonary Tuberculosis (M+) of 14% whilst the cure rate was 34%; the defaulter rate which was 9.3%.

Treatment of hypertension in rural Cambodia: results from a 6-year programme

Authors: P Isaakidis, M-E Raguenaud, C Say, H De Clerck, C Khim, R Pottier, S Kuoch, U Prahors, S Chour, W Van Damme & T Reid. Treatment of hypertension in rural Cambodia: results from a 6-year programme. Journal of Human Hypertension:
http://www.nature.com/jhh/journal/vaop/ncurrent/abs/jhh201049a.html

Abstract

This study was aimed to describe the outcomes of a hypertension treatment programme in two outpatient clinics in Cambodia. We determined proportions of patients who met the optimal targets for blood pressure (BP) control and assessed the evolution of mean systolic and diastolic BP (SBP/DBP) over time. Multivariate analyses were used to identify predictors of BP decrease and risk factors for LTFU. A total of 2858 patients were enrolled between March 2002 and June 2008 of whom 69.2% were female, 30.5% were aged greater than or equal to64years and 32.6% were diabetic. The median follow-up time was 600 days. By the end of 2008, 1642 (57.4%) were alive-in-care, 8 (0.3%) had died and 1208 (42.3%) were lost to follow-up. On admission, mean SBP and DBP were 162 and 94 mm Hg, respectively. Among the patients treated, a significant SBP reduction of 26.8 mm Hg (95% CI: 28.4–25.3) was observed at 6 months. Overall, 36.5% of patients reached the BP targets at 24 months. The number of young adults, non-overweight patients and non-diabetics reaching the BP targets was more. Older age (>64 years), uncontrolled DBP (greater than or equal to90 mm Hg) on last consultation and coming late for the last consultation were associated with LTFU, whereas non-diabetic patients were 1.5 times more likely to default than diabetics (95% CI: 1.3–1.7). Although the definite magnitude of the BP decrease due to antihypertension medication over time cannot be assessed definitely without a control group, our results suggest that BP reduction can be obtained with essential hypertension treatment in a large-scale programme in a resource-limited setting.

Keywords: treatment outcomes; diabetes; chronic diseases; resource-limited settings; Cambodia