High mortality and prevalence of HIV and tuberculosis in adults with chronic cough in Malawi: a cohort study

Nliwasa, M., MacPherson, P. , Mukaka, M., Mdolo, A., Mwapasa, M., Kaswaswa, K., Msefula, C., Chipungu, G., Mwandumba, H.C. and Corbett, E.L. (2016) High mortality and prevalence of HIV and tuberculosis in adults with chronic cough in Malawi: a cohort study. International Journal of Tuberculosis and Lung Disease, 20(2), pp. 202-210. (doi: 10.5588/ijtld.15.0388) (PMID:26792472) (PMCID:PMC4711670)

Abstract

BACKGROUND: Adults with suspected tuberculosis (TB) in health facilities in Africa have a high risk of death. The risk of death for adults with suspected TB at community-level is not known but may also be high. METHODS: Adults reporting cough of ⩾ 2 weeks (coughers) during a household census of 19 936 adults in a poor urban setting in Malawi were randomly sampled and age-frequency matched with adults without cough ⩾ 2 weeks (controls). At 12 months, participants were traced to establish vital status, offered human immunodeficiency virus (HIV) testing and investigated for TB if symptomatic (sputum for Xpert® MTB/RIF, smear microscopy and culture). RESULTS: Of 345 individuals with cough, 245 (71%) were traced, as were 243/345 (70.4%) controls. TB was diagnosed in 8.9% (16/178) of the coughers and 3.7% (7/187) of the controls (P = 0.039). HIV prevalence among coughers was 34.6% (56/162) and 18.8% (32/170) in controls (P = 0.005); of those who were HIV-positive, respectively 26.8% and 18.8% were newly diagnosed. The 12-month risk of death was 4.1% (10/245) in coughers and 2.5% (6/243) in controls (P = 0.317). CONCLUSION: Undiagnosed HIV and TB are common among adults with chronic cough, and mortality is high in this urban setting. Interventions that promote timely seeking of HIV and TB care are needed.

• Item Type: Articles
• Additional Information: PM was supported by the Wellcome Trust (grant number: WT089673). ELC was funded by a Wellcome Trust Senior Research Fellowship in Clinical Science (grant number: WT091769). Research was funded by the Helse Nord Tuberculosis Initiative (Blantyre, Malawi) and the Malawi-Liverpool-Wellcome Trust (Blantyre, Malawi).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Peter
• Authors: Nliwasa, M., MacPherson, P., Mukaka, M., Mdolo, A., Mwapasa, M., Kaswaswa, K., Msefula, C., Chipungu, G., Mwandumba, H.C., and Corbett, E.L.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: International Journal of Tuberculosis and Lung Disease
• Publisher: International Union Against Tuberculosis and Lung Disease
• ISSN: 1027-3719
• ISSN (Online): 1815-7920
• Copyright Holders: Copyright © 2016 Nliwasa et al.
• First Published: First published in International Journal of Tuberculosis and Lung Disease 20(2): 202–210
• Publisher Policy: Reproduced under a Creative Commons licence