Investigating TB / HIV Co-Infection in a HIV / AIDS Community Care Center in South India
Abstract
HIV and tuberculosis (TB) epidemics overlap considerably in low and middle income countries such as India. HIV / TB co-infection presents a challenge to providers due to atypical clinical presentations which challenge diagnosis and treatment. Additionally, India’s HIV epidemic afflicts already marginalized populations who often face barriers to care. Most studies on HIV and TB populations in India come from large tertiary care academic centers. These investigations do not capture the rural HIV epidemic, as such patients seek care at local community care centers instead. This investigation analyzed data on HIV / TB patients treated at Accept Care Home, a community care center located on the outskirts of Bangalore, India. Patients with HIV and active TB diagnoses during the three-year study period were included. Patients’ sociodemographic and clinical information was abstracted by Accept staff members. De-identified data was analyzed to ascertain a profile of Accept Care Home’s patient population. A major clinical variable of interest was the physical location of TB infection. Pulmonary is the common site of TB infection. However, patients dually afflicted by TB and HIV are more prone to atypical presentations such as extrapulmonary TB, which is harder to diagnose and to treat. Over 80% of patients were local, from in and around the Bangalore area. Nearly twice as many men as women were treated at Accept, and the men were on average older than the women. Women were more socially disadvantaged than their male counterparts in terms of educational attainment, monthly income, and marital status (most women were widowed). Men were more likely than women to be exposed to substances including alcohol, smoking, tobacco, and pan. Despite social disparities, there were no major gender differences in clinical markers for HIV and TB. There were no significant associations between sociodemographic characteristics and TB infection site (pulmonary vs. extrapulmonary). Most patients had sputum positive pulmonary TB and were diagnosed with TB for the first time. Most were in Stage IV HIV, at which HIV has converted to AIDS, and were new patients to Accept. Of interest to providers, most patients with pulmonary TB had early stage (I – III) HIV, while most patients with extrapulmonary TB had late stage HIV (Stage IV). The data underscore the social disadvantage of patients seeking treatment at Accept, and provide insight for clinicians at Accept. For example, providers should be watchful for atypical pulmonary TB symptoms in early stage HIV patients, and for signs of extrapulmonary TB in later stage HIV patients. Outside the clinic, building partnerships with local tertiary care centers can strengthen quality of care provision and allow Accept to reach a larger population.
Subject Area
Epidemiology|South Asian Studies
Recommended Citation
Kaushik, Charanya, "Investigating TB / HIV Co-Infection in a HIV / AIDS Community Care Center in South India" (2017). Texas Medical Center Dissertations (via ProQuest). AAI10615482.
https://digitalcommons.library.tmc.edu/dissertations/AAI10615482