|TB/HIV: a Clinical Manual (WHO - OMS, 1996, 135 p.)|
HIV-related tuberculosis (TB/HIV) is common in various populations, especially in sub-Saharan Africa and, increasingly, in Asia and South America. Many countries where tuberculosis is common have national tuberculosis control programmes. HIV infection increases the demands on these programmes, which are struggling to cope with the increased tuberculosis case load. The rise in tuberculosis suspects is putting a strain on diagnostic services. Extra-pulmonary and smear-negative pulmonary tuberculosis cases, which are more difficult to diagnose, account for an increased proportion of total cases. There are more adverse drug reactions. There is a higher morbidity and mortality, partly due to other, curable, HIV-related infections. The risk of tuberculosis recurrence is higher.
The essential activities of tuberculosis control are the same even in populations where HIV infection is common. The objectives of a tuberculosis control programme are to decrease morbidity, mortality and transmission of tuberculosis, while avoiding the emergence of drug resistance. The WHO strategy is to provide short-course chemotherapy under direct observation to, at least, all identified smear-positive cases. The provision of short-course chemotherapy for tuberculosis patients is one of the most cost-effective of all health interventions. The aim is to achieve global targets of 85% cure rate and 70% case detection rate. The impact of HIV exposes any weaknesses in tuberculosis control programmes. The HIV epidemic heightens the need to focus on the identification and cure of infectious tuberculosis patients.
This manual is mainly for doctors and other health professionals who work in district hospitals and health centres in high HIV and tuberculosis prevalence countries. At present, the biggest burden of TB/HIV is in sub-Saharan Africa, so this manual mainly deals with sub-Saharan Africa. However, we hope the manual will also be helpful in other parts of the world where the problem of TB/HIV is increasing.
Facilities vary from hospital to hospital. In this manual we assume your hospital has a small laboratory and X-ray service. Even if you do not have these facilities, we hope that the manual will still be useful. Health professionals who care for tuberculosis patients now need to know how to diagnose and treat tuberculosis and other HIV-related diseases. This manual will help you in this task.
The manual fits into a white coat pocket so you can use it on the ward, in the clinic and at home. There is not enough room in a pocket manual for all the possible information you may want to know about TB/HIV. So, at the end of each chapter there are suggestions for further reading. These suggestions include relevant books, background material, reviews and recent articles in journals.
Since English is not the first language of many of the people using this manual, the writing style is deliberately simple. For brevity, the use of the words he/him/his stands also for she/her/hers where the text could refer to either a man/boy or a woman/girl.
You are welcome to send any comments on the manual to the WHO Global Tuberculosis Programme. We will use your comments to help improve future editions. Many of the references in the manual are to WHO publications. To order copies of WHO publications, you should contact WHO Publications, Distribution and Sales, 1211 Geneva 27, Switzerland.