Prevalence of HIV infection and bacteriologically confirmed tuberculosis among individuals found at bars in Kampala slums, Uganda

Abstract

Individuals found at bars in slums have several risk factors for HIV and tuberculosis (TB). To determine the prevalence of HIV and TB among individuals found at bars in slums of Kampala, Uganda, we enrolled adults found at bars that provided written informed consent. Individuals with alcohol intoxication were excluded. We performed HIV testing using immunochromatographic antibody tests (Alere Determine HIV-1/2 and Chembio HIV 1/2 STAT-PAK). TB was confirmed using the Xpert MTB/ RIF Ultra assay, performed on single spot sputum samples. We enrolled 272 participants from 42 bars in 5 slums. The prevalence of HIV and TB was 11.4% (95% CI 8.1-15.8) and 15 (95% CI 6-39) per 1,000 population respectively. Predictors of HIV were female sex (aOR 5.87, 95% CI 2.05-16.83), current cigarette smoking (aOR 3.23, 95% CI 1.02-10.26), history of TB treatment (aOR 10.19, 95% CI 3.17-32.82) and CAGE scores of 2-3 (aOR 3.90, 95% CI 1.11-13.70) and 4 (aOR 4.77, 95% CI 1.07-21.35). The prevalence of HIV and TB was twice and four times the national averages respectively. These findings highlight the need for concurrent programmatic screening for both HIV and TB among high risk populations in slums. HIV and tuberculosis (TB) interact at an epidemiological, clinical, cellular, and molecular level to create a coepidemic 1. In 2018, HIV contributed 251,000 of the 1.2 million TB deaths while TB was the leading cause of death among HIV positive individuals 2,3. Notwithstanding, an estimated 3 million TB cases were missed in 2018 and only 79% of HIV-positive individuals knew their HIV status 2,3. To increase the detection of TB and HIV, it is important to target high risk and vulnerable populations through active community based screening strategies 4-6. Slum dwellers have a higher risk for HIV, TB and HIV/TB co-infection than the national averages 7,8. However, slum dwellers are less likely to utilise health services for HIV and TB diagnosis and have a low level of knowledge regarding prevention strategies for either disease 9,10. The low utilisation is partly attributed to the perceived poor quality of services at public facilities and thus high risk groups are not covered by facility based screening strategies 11,12. Within slum settlements, bars and social drinking places carry the highest risk for TB transmission than other social gathering places such as churches, clinics, hospitals, taxis, community halls, schools, and supermarkets 13-16. As such, bars and social alcohol drinking groups are avenues for TB transmission to bar customers, employees and neighbours, and they propagate outbreaks from an index case 17-21. Moreover, alcohol consumption is an established risk factor for tuberculosis in a dose dependent fashion, and exacerbates TB infection by blunting CD4 and CD8 T-lymphocyte cellular responses 22,23 .

Prevalence of HIV among newly diagnosed tuberculosis patients in Erbil Governorate, Iraq

“…Also, women are renowned to have a higher predisposition to HIV infection and are usually subjected to sexual behaviors earlier than men at most due to economic circumstances. 27,28 Sentinel observational study accomplished in Delhi by Jain et al 29 in 1997-98 proposed a higher jeopardy of HIV co-infection existing among males complaining from TB which is in harmony with the present study. In the current study, HIV/TB patients were found to have a male-to-female ratio of 2.4.…”

“…29,33 The other possible elucidation for this may be their increased family, organizational, and societal responsibilities as people in this age group involve themselves in various peculiar and distinctive daily activities in order to win the socioeconomic tribulation which increases the frequency of their contact with other patients in their society. 28,34 The aforementioned outcomes of this study support this fact as the majority of the TB-HIV co-infected patients were in the productive age group 31-40 years, mostly illiterate and lack of skills. All these factors in linking with unsafe sexual practice were found to be the major cause of HIV transmission.…”

“…In the current study, HIV/TB patients were found to have a male-to-female ratio of 2.4. Others have found that the male/female ratio of HIV-associated TB in Africa was 0.83, 28 although in other territories such as the Western Pacific, that ratio was 3.1. 32 The ration of the current study is akin to the ratio of 2.7 revealed in 16 WHO European countries in 2005 and signaled that both infectious diseases are more widespread in the male population.…”

“…Excepting a few nations in Africa (Sub-Saharan Africa), the prevalence of co-infection has been proclaimed to be higher among males than females. [25][26][27][28] The prevalence of HIV is known to be higher among women than men in sub-Saharan Africa as a consequence of several reactions to sociodemographic risk factors, sexual attitude, and HIV/AIDS knowledge. Also, women are renowned to have a higher predisposition to HIV infection and are usually subjected to sexual behaviors earlier than men at most due to economic circumstances.…”

“…25 The TB/HIV encumbrance was also had been observed to be higher within the age group that is mostly affected by TB. 28 A study notified that the greatest leverage of the embarkation in TB extent had been on people between 25 and 45 years of age, since this is the age group mainly affected by HIV. 29 This age prevalence of HIV co-infection among TB patients likely point out the age-specific prevalence of HIV in the community.…”