TB & HIV: Counseling & Testing in Tandem - Cote d'Ivoire

OBJECTIVES:

To describe the implementation of a free, voluntary and confidential HIV counseling and testing programme for patients with newly diagnosed tuberculosis at the eight large outpatient tuberculosis centers in Cote d'Ivoire, and to present epidemiologic findings on participating patients.

DESIGN:

HIV counseling and testing programme with ongoing HIV serosurveillance.

METHODS:

HIV counseling and testing services were established at the twotuberculosis centers in Abidjan in 1989 and were extended to six centersin the Cote d'Ivoire interior in the first half of 1994. Characteristicsof counseled patients, acceptance rates of HIV testing, and HIV serologicresults were analyzed for all eight centers from 1994 to 1996. Temporaltrends in HIV seropositivity rates were examined for the two centers ofAbidjan from 1989 to 1996.

RESULTS:

From July 1994 through December 1996, 17 946 (91.8%) out of 19594 patients who were counseled at the eight centers in Cote d'Ivoireconsented to HIV testing, of whom 7749 (43.2%) were HIV-seropositive. Thehighest rates of 47.0 and 45.6% were found in the two centers in Abidjan,with rates ranging from 32.9 to 42.4% in the six centers in the interior.HIV-seropositive tuberculosis patients from each of the 50 districts inCote d'Ivoire were identified. In Abidjan, the HIV seropositivity rateremained relatively stable among men (46.7% in 1989, 48.5% in 1991, 43.6%in 1996), but rose sharply among women from 32.7% in 1989 to 50.1% in1996.

CONCLUSIONS:

The high HIV seropositivity rates among tuberculosis patients in all geographic regions of Côte d'Ivoire indicate that the HIV epidemic has now spread throughout the country. However, the successful implementation of an extensive HIV counseling and testing program for more than 37000 tuberculosis patients to date demonstrates the commitment of the Cote d'Ivoire Ministry of Health to integrating HIV/AIDS prevention activities with tuberculosis control efforts. When logistically and economically feasible, the extension of HIV-related social and clinical services to HIV-seropositive tuberculosis patients should be considered by other national tuberculosis control programs in Africa.

For more information, contact

Dr Lucien Y Abouya

Medical research scientist

Cote d'Ivoire

yla0@cdc.gov