Tuberculosis and HIV infection in health workers in the Maputo Central Hospital, the national reference hospital of Mozambique
Background : In Mozambican hospitals, HIV drives transmission of tuberculosis (TB). This study employs active case finding along with latent TB infection (LTBI) and HIV screening to identify health workers (HW) at high risk for active TB.
Methods : HW at Maputo Central Hospital (MCH) completed a symptom screen, chest X-ray, tuberculin skin- (TST), HIV- and Quantiferon TB-gold (QFT) testing. Sputum samples for acid-fast smear, mycobacterial culture and GeneXpert were solicited from symptomatic patients and those with suspicious X-ray findings. A logistic multivariate analysis with adjusted odds ratios is reported.
Results : In 690 enrolled HW, 4 cases of active TB were diagnosed. 425 (62%) LTBI cases were identified, 284 (67%) were classified as high-risk LTBI (Fig 1), 186 are on INH preventive therapy. 12% of HW were HIV+ with no significant difference between those with and without TB infection including LTBI (p=0.3). The TST had a positive predictive value for QFT positivity of 82% in HIV+ individuals (95% CI 63 -- 94) which did not differ significantly in HIV- individuals (79%, 95%CI 74 -- 84). In the multivariate analysis, duration of service at MCH had a significant impact on LTBI (Fig 2) as did department of service (Fig 3).
Conclusion : Active and latent TB prevalence was high among HW at MCH. Furthermore, workers in several departments are at significantly higher risk of LTBI suggesting specific occupational risk, and indicating good targets for intervention including implementation of "FAST" (Finding TB cases Actively, Separating safely, Treating effectively). Follow-up is planned to evaluate the incidence of LTBI, active TB, and adherence to isoniazid preventive therapy.
S. K. Graves,
S. Viegas, None
O. Augusto, None
A. Hassane, None
P. Lederer, None
K. Lee, None
S. Amade, None
S. Peleve, None
E. A. Nunes, None
F. Torriani, None