Tuberculosis and HIV/AIDS

This very short medical communication proposes that potent NRF2-activating dietary supplements (like resveratrol, sulforaphane, curcumin, “Asea redox supplement” [ARS] etc.) should be clinically tested as safe adjuvants (in various combinations) in all types of medium and severe cases of aggressive respiratory viral infections (including Influenza A/B/C, SARS, MERS, COVID-19, measles, avian influenza etc., including those patients who have important comorbidities like HIV/AIDS, tuberculosis [TB] etc.) based on their extrapolated cytoprotective antioxidant effects (especially on the main vital organs: brain, heart, lungs, kidneys and liver), including the extrapolated strong cytoprotection offered by ARS on the cardiac muscle of DMD patients (which can be extrapolated to the lungs), like the author of this paper has demonstrated in past papers.
#DONATIONS. Anyone can donate for dr. Dragoi’s independent research and original music at: https://www.paypal.com/donate/?hosted_button_id=AQYGGDVDR7KH2

Introduction: Worldwide tuberculosis was top ten cause of death alongside, Human Immunodeficiency Virus (HIV) in 2018; 10.0 million people became ill with tuberculosis with 1.2 million deaths occurring among HIV negative people while an additional 251,000 were HIV positive. Isoniazid preventive therapy (IPT), intensified case finding, and infection
control have been widely recommended to reduce the burden of TB in people living with Human Immunodeficiency
Virus (PLHIV). IPT works synergistically but independently
of antiretroviral therapy (ART) to reduce the morbidity, mortality and incidence of tuberculosis among PLHIV, but its uptake has been slow in most developing countries.
Objective: This study sought to find the effect of isoniazid
preventive therapy on prevalence of tuberculosis among HIV patients attending Bahati comprehensive care centre.
Materials and Methods: A retrospective cohort study was conducted over a seven month period among consented
346 people living with Human Immunodeficiency Virus (HIV) residing in Makadara Nairobi County, attending Bahati comprehensive care centre with signs and symptoms of TB. Sampled sputa from the participants were analyzed for detection of Mycobacterium tuberculosis by GeneXpert MTB/RIF assay and culture by BACTEC MGIT 960. Socio demographic
and laboratory data was collected and the data was analyzed using SPSS version 20.0.
Results: Of the three hundred and forty six sputa sampled
and analyzed, 10(6.5%) and 67(35.1%) IPT and non-IPT patients had Mycobacterium tuberculosis detected respectively;
P=0.001. On the other hand 57(18.2%) and 20(60.6%) new and retreatment patients had Mycobacterium tuberculosis
detected respectively.

The present investigation was carried out to determine the possible bioactive components of tuber of Ruellia tuberosa L. (Acanthaceae) using GC-MS analysis. Twenty five compounds were identified. The prevailing compounds in the ethanol extract of tuber of R. tuberosa were Lupeol (68.14%), Stigmasterol (8.89%), á-Sitosterol (3.99%), Sucrose (2.24%), Cholest-5-ene, 3-bromo-, (3á- (2.24%), Octadecane, 2-methyl- (2.10%), Nonadecane, 2-methyl- (1.93%), Eicosane, 2-methyl- (1.79%) Heptacosane (1.43%) and Heptacosane (1.29%).

This essay suggests that there is great value to be gained from looking at the history of the major threats to health that humans have endured throughout human (and even hominin) history.  The possibilities for multi-disciplinary work in the field of global health history have never been richer.  Work in genetics, paleopathology, and traditional forms of documentary History can now be combined to reconstruct the histories of the oldest global diseases (tuberculosis and leprosy) to the newest (HIV/AIDS).  All these narratives show the need to think systematically about the manifold forces that create and sustain diseases throughout the world. http://www.ashgate.com/isbn/9781409409243

Dr. Debrework Zewdie, former Director (September 1994–November 2014) of the World Bank Global AIDS Program and Deputy Executive Director and COO of the Global Fund, is an Ethiopian national who has led strategy, policy implementation, and management of development programs at country, regional, and global levels for international bodies such as the World Bank and The Global Fund to Fight AIDS, Tuberculosis and Malaria. As an immunologist, she conceptualized and managed the groundbreaking US$1 billion Multi-country HIV/AIDS Program that changed the AIDS funding landscape and pioneered the large-scale multi-sectorial response with direct financing to civil society and the private sector. Dr. Zewdie led the articulation of the World Bank’s first global strategy on HIV/AIDS and the Global HIV/AIDS Program of Action. As a founding UNAIDS Global Coordinator, she has been instrumental in making the unique cooperative structure of the UNAIDS family a working reality, fostering strong inter-agency partnerships. She is an advocate for women’s health and was a founding Vice President and member of the Society for Women and AIDS in Africa (SWAA). She established institutional rigor at the Global Fund and led its wide-ranging internal reform which culminated in the ongoing corporate transformation program. Dr. Zewdie has a Ph.D. in clinical immunology from the University of London, completed a postdoctoral fellowship at SYVA Diagnostics, Inc. (a Black-owned diagnostic company in Palo Alto, California), and was a Senior MacArthur Fellow] at the Harvard Center for Population and Development Studies. Dr. Zewdie is a Richard L. and Ronay A. Menschel Senior Leadership Fellow at the Harvard T.H. Chan School of Public Health in 2015.

Context: According to a report by the World Health Organization (WHO), there were 1.4 million deaths worldwide in 2015 from tuberculosis (TB), with 3.9% being new cases and 21% being previously treated cases of multidrug-resistant tuberculosis (MDR-TB).

Aims: To review the literature concerning the costing analysis situation of MDR-TB treatment.

Methods: The study was conducted as a systematic review, with a modified checklist being used as the vital instrument. A search was performed of three databases (PubMed, Cochrane, and Scopus) using the terms (cost OR economic, socioeconomic, expenditure, burden, fee, charge, budget impact) AND (resistance OR multidrug resistance, MDR) AND (tuberculosis OR TB, Mycobacterium tuberculosis) in order to identify relevant articles published from 2006 to the present.

Results: A total of 1238 abstracts were identified, and 12 papers were ultimately included in the study. The quantity of the published articles was found to increase during in the period 2008 to 2016. Almost all the studies were based on patients’ and healthcare systems’ perceptions. The main data sources used were medical establishments and the reports of various relevant organizations. Primary data were used twice as much as secondary data. All the costing types, including direct costs and indirect costs, were mentioned, albeit not with the same frequency.

Conclusions: Africa owns one-third of the articles included. Further, it was found that MDR-TB should be treated using ambulatory care rather than hospital-based models. Future research studies should focus on Asia, where drug resistance has proved to be a challenging issue.

Background: Even though the proportion of previously treated TB patients’ (retreatment cases) is increasing at
alarming rate, there is scarcity of data regarding their magnitude and treatment outcomes. Therefore, this study is
meant to assess TB retreatment case rate and their treatment outcomes at Adama hospital medical college (AHMC)
in Ethiopia.
Methods: The study employed a retrospective cross-sectional survey where a total of 732 registered TB patients’
data were reviewed between Aprils to May 2014. Data analysis was done using SPSS version 20.0.
Results: In this study, 147 (20%) of 732 TB cases were registered as retreatment cases. Of these, 16 (11%)
relapse, 13 (9%) return after defaulted (RAD), 23 (16%) failure and 95 (64%) were categorized as ‘other’ among
which 61 (64.9%) had sputum smear-negative pulmonary TB (PTB) and 34 (35.1%) had extra PTB (EPTB).
Retreatment case is more likely to occur in HIV positive 48 (59%) individuals. Regarding their treatment outcomes,
treatment success rate (cure plus treatment completed) of 65 (63.7%) was obtained. Whereas 13 (12.8%) registered
as died, 10 (9.8%) as failure, 9 (8.8%) as defaulters and 5 (4.9%) as transferred out cases to other health facility.
HIV positive individuals are more likely (54%) to have poor treatment outcomes.
Conclusion: The prevalence of TB retreatment cases obtained in this study was higher as compared to similar
studies. Similarly, their treatment success rate (TSR) was lower as compared to the national figure. Therefore, more
attention should be given to the prevention and treatment of TB retreatment cases to avoid social and economic
burden of tuberculosis in Ethiopia.

This Research Paper deals with the following constellation of issues: Tuberculosis and Poverty; Tuberculosis and Human Rights violations apropos the following rights: Right to Non-Discrimination and Equality, Right to Life, Right to the Highest Attainable Standard of Physical and Mental Health, Right to Bodily Integrity, Right to Freedom of Movement, Right to Freedom from Arbitrary Arrest and Detention, Right to Fair Trial, Right of All Persons Deprived of their Liberty to be treated with Humanity, Right to Freedom from Torture or Cruel, Inhuman or Degrading Treatment or Punishment, Right to Privacy, Right to Freedom of Expression and Right to Information, Right to Freedom of Assembly and Association, Right to Enjoy the Benefits of Scientific Progress and its Application; Tuberculosis and Key Vulnerable Groups (Women, Children, Migrants, Refugees and Prisoners). This paper argues that, fight against Tuberculosis via the social mobilization approach is the best way forward. Lastly, author concludes with the following finding of fact: ‘Recognizing TB as a social, economic and political disease, and not just a medical problem, will prompt the need to explore new avenues through which efforts to ensure TB prevention and access to TB cure will be strengthened.’

Pulmonary disease is common in HIV-infected patients. Diagnostic means, however, are often scarce in areas where most HIV patients are living. Chest ultrasonography has recently evolved as a highly sensitive and specific imaging tool for diagnosing chest conditions such as pneumothorax, pneumonia and pulmonary edema in critically ill patients. This article addresses the issue of imaging and differentiating common pulmonary conditions in HIV-infected patients by chest ultrasonography. We report chest ultrasound features of five different common pulmonary diseases in HIV-infected patients (bacterial pneumonia, Pneumocystis jirovecii pneumonia, tuberculosis, cytomegalovirus pneumonia and non-Hodgkin lymphoma) and review the respective literature. We observed characteristic ultrasound patterns especially in Pneumocystis jirovecii pneumonia and pulmonary lymphoma. Further exploration of chest ultrasonography in HIV-infected patients appears promising and may translate into new diagnostic...

NTRODUCTION:

Pulmonary disease is common in HIV-infected patients. Diagnostic means, however, are often scarce in areas where most HIV patients are living. Chest ultrasonography has recently evolved as a highly sensitive and specific imaging tool for diagnosing chest conditions such as pneumothorax, pneumonia and pulmonary edema in critically ill patients. This article addresses the issue of imaging and differentiating common pulmonary conditions in HIV-infected patients by chest ultrasonography.
METHODS:

We report chest ultrasound features of five different common pulmonary diseases in HIV-infected patients (bacterial pneumonia, Pneumocystis jirovecii pneumonia, tuberculosis, cytomegalovirus pneumonia and non-Hodgkin lymphoma) and review the respective literature.
CONCLUSIONS:

We observed characteristic ultrasound patterns especially in Pneumocystis jirovecii pneumonia and pulmonary lymphoma. Further exploration of chest ultrasonography in HIV-infected patients appears promising and may translate into new diagnostic approaches for pulmonary conditions in patients living with HIV.

Tuberculosis (TB) is known to be one of the oldest forms of human diseases which remain the leading cause of death which occurs due to accumulation of Mycobacterium tuberculosis (MTB) onto the lungs alveolar surfaces. M. tuberculosis is an implicated pathogenic bacteria associated with T.B. It is the chronic infectious disease caused by the tubercle bacillus (M. tuberculosis). This study was aimed to determine co patients attending Federal Medical Centre (FMC), Katsina. The study design was cross sectional, conducted to isolate some pathogenic bacteria that co who are Acid fast bacilli (AFB) positive and AFB negative. The samples obtained were cultured on Blood, Chocolate and MacConkey agar and incubated at 37 Pure isolates were confirmed using Grams Staining and biochemical reaction. Data obtained were presented as simple percentage and using statistical analysis which revealed that the incidence was common among the age categories 51 followed by those ≥60 years with 2 category 11-20 with 10%. Based on gender, males presented with the higher incidence (35/50) i.e. 70% than female (15/50) i.e. 30%. Klebsiella pneumoniae, Staphyllococcus aureus and Pseudomonas aeruginosa we 21.9%, 19.66% and 19.10% respectively. E. coli with 05.62% being had the least isolates. The research demonstrated the existence of both Gram positive and Gram negative bacterial pathogens that co elderly males. Further research should be tailored towards investigating other pathogens that co-infect with MTB patients, such as fungi and viruses, in diversified hospitals in Katsina state and beyond.

BackgroundThe performance of the tuberculosis specific Interferon Gamma Release Assays (IGRAs) has not been sufficiently documented in tuberculosis- and HIV-endemic settings. This study evaluated the sensitivity of the QuantiFERON TB-Gold In-Tube (QFT-IT) in patients with culture confirmed pulmonary tuberculosis (PTB) in a TB- and HIV-endemic population and the effect of HIV-infection and CD4 cell count on test performance.Methodology/Principal Findings161 patients with sputum culture confirmed PTB were subjected to HIV- and QFT-IT testing and measurement of CD4 cell count. The QFT-IT was positive in 74% (119/161; 95% CI: 67–81%). Sensitivity was higher in HIV-negative (75/93) than in HIV-positive (44/68) patients (81% vs. 65%, p=0.02) and increased with CD4 cell count in HIV-positive patients (test for trend p=0.03). 23 patients (14%) had an indeterminate result and this proportion decreased with increasing CD4 cell count in HIV-positive patients (test for trend p=0.03). Low CD4 cell count (<300 cells/µl) did not account for all QFT-IT indeterminate nor all negative results. Sensitivity when excluding indeterminate results was 86% (95% CI: 81–92%) and did not differ between HIV-negative and HIV–positive patients (88 vs. 83%, p=0.39).Conclusions/SignificanceSensitivity of the QFT-IT for diagnosing active PTB infection was reasonable when excluding indeterminate results and in HIV-negative patients. However, since the test missed more than 10% of patients, its potential as a rule-out test for active TB disease is limited. Furthermore, test performance is impaired by low CD4 cell count in HIV-positive patients and possibly by other factors as well in both HIV-positive and HIV-negative patients. This might limit the potential of the test in populations where HIV-infection is prevalent.

Background To evaluate the pharmacokinetic of plasma lopinavir (LPV) and ritonavir (RTV) when co-administered with three times weekly (TPW) rifabutin (RBT) at a dose of either 150 or 300 mg in African tuberculosis (TB) and HIV co-infected adult patients. Methods This is a pharmacokinetic study conducted in Ouagadougou among patients treated with a standard dosage of LPV/RTV 400/100 mg twice daily and RBT 150 mg TPW (arm A = 9 patients) or rifabutin 300 mg TPW (arm B = 7 patients) based regimens. Patients were recruited from the Bogodogo and Kossodo district hospitals in Ouagadougou from May 2013 to December 2015. Study inclusion criteria were that the patients were between 18 and 60 years of age, HIV-1 infected with pulmonary tuberculosis confirmed or suspected. Subsequent blood samples for pharmacokinetic monitoring were collected at 1, 2, 3, 4, 6, 8 and 12 h after combined drug ingestion for plasma drug monitoring using HPLC/MS assays. Results The medians LPV Cmax and Tmax were re...

Background: The prevention of mother-to-child transmission (PMTCT) programmes plays a significant role in the reduction of human immunodeficiency virus (HIV) infections in the under-five age group and maternal mortalities. A phenomenological study on the experiences of HIV-positive women who utilised the PMTCT services identified challenges affecting the use of those services. An enabling environment is required for the effectiveness of the PMTCT programme. Purpose: The purpose of this paper is to develop and describe a model for enhancing prevention of mother-tochild HIV transmission in a low-resource setting. Method: The model was developed in three sequential phases: empirical foundation, development of the model and description of the model. The model was developed using Walker and Avant's steps of theory development. Chinn and Kramer's criteria were used to evaluate the model and the modified version of the Delphi technique was utilised for peer review and further refinement of the model. This emanated from findings of a doctoral thesis on the experiences of HIV-positive PMTCT clients at a central hospital in Zimbabwe. The procedure involved the use of systems theory, central concept identification, a literature review, the definition of key terms and the identification of the elements of the model, after which the model was developed, described, and evaluated. Results: The elements of the model encompass the context, input, process and outcome. Conclusion: The model will act as a reference framework for midwives and programme planners with a view of enhancing utilisation and the quality of PMTCT services.

Background: This study aimed to assess the pharmacokinetic profile of 150 mg rifabutin (RBT) taken every other day (every 48 h) versus 300 mg RBT taken every other day (E.O.D), both in combination with lopinavir/ritonavir (LPV/ r), in adult patients with human immunodeficiency virus (HIV) and tuberculosis (TB) co-infection. Methods: This is a two-arm, open-label, pharmacokinetic, randomised study conducted in Burkina Faso between May 2013 and December 2015. Enrolled patients were randomised to receive either 150 mg RBT EOD (arm A, 9 subjects) or 300 mg RBT EOD (arm B, 7 subjects), both associated with LPV/r taken twice daily. RBT plasma concentrations were evaluated after 2 weeks of combined HIV and TB treatment. Samples were collected just before drug ingestion and at 1, 2, 3, 4, 6, 8, and 12 h after drug ingestion to measure plasma drug concentration using an HPLC-MS/MS assay. Results: The Cmax and AUC 0-12h medians in arm A (Cmax = 296 ng/mL, IQR: 205-45; AUC 0-12h = 2528 ng.h/mL, IQR: 1684-2735) were lower than those in arm B (Cmax = 600 ng/mL, IQR: 403-717; AUC 0-12h = 4042.5 ng.h/mL, IQR: 3469-5761), with a statistically significant difference in AUC 0-12h (p = 0.044) but not in Cmax (p = 0.313). No significant differences were observed in Tmax (3 h versus 4 h). Five patients had a Cmax below the plasma therapeutic limit (< 300 ng/mL) in the 150 mg RBT arm, while the Cmax was above this threshold for all patients in the 300 mg RBT arm. Additionally, at 48 h after drug ingestion, all patients had a mycobacterial minimum inhibitory concentration (MIC) above the limit (> 64 ng/mL) in the 300 mg RBT arm, while 4/9 patients had such values in the 150 mg RBT arm. Conclusion: This study confirmed that the 150 mg dose of rifabutin ingested EOD in combination with LPV/r is inadequate and could lead to selection of rifamycin-resistant mycobacteria.

EXECUTIVE SUMMARY
Globally, an estimated 35.3 million people were living with Human Immunodeficiency Virus (HIV) in 2012. An increase from previous years as more people are receiving the life-saving antiretroviral therapy. There were 2.3 million new HIV infections globally in 2012, showing a 33% decline in the number of new infections from 3.4 million in 2001. At the same time, the number of AIDS related deaths are also declining, with 1.6 million AIDS deaths in 2012, down from 2.3 million in 2005 (UNAIDS, 2013).
Sub-Saharan Africa remains the epicenter of the epidemic and accounted for nearly 70% of the world’s burden of HIV and AIDS. South Africa is the worst affected country with an estimated 6.3 million people living with HIV, which is the largest number of people living with HIV and AIDS
in the world. Since 1990, this generalised HIV epidemic trend is monitored annually through the national antenatal sentinel surveillance tool. Since 2006, the HIV prevalence trends are published and reported at national, provincial and in the 52 districts, and disaggregated by age.
The goal of the national antenatal sentinel HIV prevalence survey is to produce robust scientific evidence at national, provincial and district level in order to:

•Determine the HIV sero-prevalence amongst first time antenatal clinic attendees, seen as a particularly suitable “sentinel” group to represent most closely the HIV prevalence of the general adult sexually active part of the population
• Provide baseline empirical data for national, provincial and district level estimates and extrapolation of HIV infections for future projections of the epidemic

THE OBJECTIVES ARE:
• To estimate the national prevalence of HIV infection among pregnant women in South Africa
• To determine the geographical distribution pattern of HIV infection among pregnant women attending antenatal clinics at national and provincial level, by district and by age categories
• To monitor trends over time for both HIV prevalence at national, provincial and district level in South Africa
• To provide scientific evidence to monitor the country’s progress towards meeting the Millennium Development Goal 6, Target 7, Indicator 18 - HIV prevalence amongst 15–24 year old pregnant women
In 2013, a total of 33 077 first time antenatal care attendees participated in the survey. The sample was sufficiently representative to make conclusive inferences on HIV occurrence at national and provincial level and in all 52 health districts. Intravenous blood samples were
collected from the surveyed pregnant women in 1 497 public sector antenatal clinics during October 2013. These biological specimens were collected and sent to central laboratories in the various provinces for HIV analysis. The blood test used was the Enzyme Linked Immuno
Sorbent Assay (ELISA) for HIV antigen testing. Given that the sentinel sites were chosen on.
2. The 2013 National Antenatal Sentinel HIV Prevalence Survey, South Africa a probability proportional to size by districts, the sampling period was fixed and the districts’ samples were self-weighting, the provincial prevalence estimates were calculated as the total of the results from the districts in the provinces. The national prevalence was weighted
according to the total number of women aged 15-49 years in each province using the 2013 mid-year population size estimates. The sample population realisation rate in 2013 was 91.9% and exceeded the 70% compliance rate as outlined in the survey protocol.

THE 2013 NATIONAL HIV PREVALENCE
The national HIV prevalence for 2013 was 29.7% (95% CI: 28.9-30.2), a slight increase of 0.2% from the 29.5% in 2011 and 2012 which was not statistically significant. The epidemic curve is still plateauing and there is no statistical difference in the national HIV prevalence  estimates in the past six years. The cross sectional design of this point prevalence sentinel
surveillance does not provide the association between HIV prevalence and the number of
people on anti-retroviral therapy (ART) treatment, the design of the survey in its current form
is purely descriptive. However, there are significant differences in HIV prevalence among the nine provinces and among the 52 health districts. The HIV epidemic in South Africa has in the  past six years observed stabilisation at national level only. THE 2013 PROVINCIAL HIV PREVALENCE In the nine provinces, there is fluctuation and significant heterogeneity in HIV prevalence trends between districts over the years. In 2013, the highest provincial HIV prevalence was recorded in KwaZulu-Natal (KZN) which increased from 37.4% in 2012 to 40.1% in 2013. Provinces with ‘higher’ HIV prevalence estimates compared with 2012 are the Eastern Cape (from 29.1%  in 2012 to 31.4% in 2013), Mpumalanga (increased from 35.6% in 2012 to 37.5% in 2013). These small increases fell within the expected sampling variability. The provinces with ‘lower’
HIV prevalence estimates were: North West (from 29.7% in 2012 to 28.2% in 2013) and Free State (decreased from 32.0% in 2012 to 29.8% in 2013). Their estimates were also within the expected sampling variability.

THE 2013 HIV PREVALENCE BY DISTRICT
The district level HIV epidemic is significantly heterogeneous, with prevalence's ranging from a low of 2.3% in Namaqua in the Northern Cape to a high of 45.9% in iLembe, KwaZulu-Natal. When data is pooled over the last four years, this heterogeneity persists. The number of districts recording prevalence levels above 40% has increased from two out of 52 in 2011 to six out of the 52 districts in 2013, five in KZN and one in Mpumalanga. In 2013, there were six districts in the country (five in KwaZulu-Natal and one in Mpumalanga) recording HIV prevalence above 40%. The highest prevalence in the country was recorded in iLembe (45.9%). The other five districts recording HIV prevalence above 40.0% were: uMkhanyakude (44.1%), eThekwini (41.1%), uMgungundlovu (42.5%), Ugu (41.1%) and uThukela in KwaZulu-Natal viz. (40.0%) and Gert Sibande in Mpumalanga at 40.8%.
.
THE 2013 HIV PREVALENCE DISTRIBUTION BY AGE
From 2007 to 2013, the peak in HIV prevalence occurs in the 30-34 year olds. The HIV prevalence in this age group increased from 41.5% in 2009 to 42.5% in 2013. When comparing The 2013 National Antenatal Sentinel HIV Prevalence Survey, South Africa the HIV prevalence in the different age categories with previous years it has gone up slightly in all age groups. The higher prevalence in older age groups could be partly explained by the ART usage. The 2013 HIV prevalence among the 15-24 pregnant women is 19.9%. The baseline HIV prevalence in the 15-24 year- old pregnant in 2001 was 23.1% and it is expected to be reduced by 75% in 2015, which translates to 5.3%. It is very worrying that the trend among young people (15-24) is not showing a decline (this age group should not be affected much by ART). The UN MDG 6 baseline HIV prevalence for the 15-24 pregnant MDG group in 2001 was 23.1% and it is expected to be reduced by 75% in 2015, which translates to 5.3%. The 2013 HIV prevalence among the 15-24 pregnant women is 19.9%.The decrease in HIV prevalence in this age group is slow but not significant.
CONCLUSION
The national HIV prevalence of 29.7% among antenatal women is in line with the prevalence of 29% and 30% since 2004, which shows stabilisation at national level. It is noted that there are significant differences between the nine provinces and even more significant heterogeneity
in HIV prevalence among the 52 health districts. The high HIV prevalence amongst young ANC women (15–24 years) is a concern. Going forward, an analytical exercise is required to understand the potential hypothesis for this trend. The HIV prevalence for women aged 15-29 has fallen (declining incidence) while the prevalence of those above 30 years has risen (provision of ARVs keeping infected women alive) resulting in the combined prevalence (15-49years) remaining almost unchanged.
In conclusion, the Department will revise the current design of the protocol in the context of expanding coverage of HIV testing, prevention of mother to child transmission (PMTCT) and ART and transition to PMTCT Option B+ for HIV-positive pregnant women. The Department  will also consider the use of linked testing (confidential or anonymous) with informed consent for HIV sentinel surveillance. This will require informed consent from pregnant women who are HIV tested for surveillance, providing them and the clinic with their HIV test results, and referring them to available HIV care, treatment and prevention interventions, if the test results
are positive. Further research will be conducted to better understand what contributes to increases in HIV prevalence and the HIV prevalence levels in Mpumalanga, Western Cape and KwaZulu-Natal, and whether the increase in HIV prevalence predominantly observed among older women is needed. The interpretation of HIV prevalence trends in this age group is difficult without an in-depth analysis of HIV incidence and the impact of increasing access to ART .In the context of expanding coverage of HIV testing, PMTCT and ART and transition to PMTCT Option B+ for HIV-positive pregnant women, the Department will be conducting an
Unlinked Anonymous Testing (UAT) based sentinel surveillance which raises ethical concerns. It recommends the use of linked testing (confidential or anonymous) with informed consent for HIV sentinel surveillance. This will require informed consent from pregnant women who are HIV tested for this antenatal sentinel surveillance survey, providing them and the clinic with their HIV test results, and referring those to available HIV care, treatment and prevention

Pancreatic tuberculosis (TB) is a relatively rare disease that can mimic carcinoma, lymphoma, cystic neoplasia, retroperitoneal tumors, pancreatitis or pseudocysts. Here, I report the case of a 31-year-old immigrant Burmese woman who exhibited epigastralgia, fever, weight loss and an epigastric mass. The patient was diagnosed with pancreatic TB and acquired immunodeficiency syndrome, and was treated with antituberculous drugs and percutaneous catheter drainage without a laparotomy. The clinical presentation, radiographic investigation and management of pancreatic TB are summarized in this paper to emphasize the importance of considering this rare disease in the differential diagnosis of pancreatic masses concomitant with human immunodeficiency virus infection. I also emphasize the need for both histopathological and microbiological diagnosis via fineneedle aspiration. Ultrasound demonstrated a well-defined, lobulated cystic lesion with fluid debris at the pancreatic head. The size of the lesion is approximately 5.6 cm × 5.3 cm × 5.7 cm.

Abstract
This systematic review intended to combine factors associated with tuberculosis treatment non-adherence and lost to follow up among TB patients with/without HIV in developing countries. Comprehensive remote electronic databases (MEDLINE, (PMC, Pub Med Central), Google scholar and Web of science) search was conducted using the following keywords: Tuberculosis, treatment, compliance, adherence, default, behavioural factors and socioeconomic factors. All types of studies intended to assess TB treatment non-adherence and lost to follow up in developing countries among adult TB patient from 2008 to data extraction date were included. Twenty-six original and one-reviewed articles, which meet inclusion criteria, were reviewed. TB treatment non-adherence and lost to follow up were continued across developing countries. The main factors associated with TB treatment non-adherence and lost to follow up were socioeconomic factors: lack of transportation cost, lack of social support, and patients-health care worker poor com-munication. Behavioural factors were Feeling better after few weeks of treatments, tobacco and alcohol use, knowledge deficit about duration of treatment and consequences of non-adherence and lost to follow up. TB treat-ment non-adherence and lost to follow up were continued across developing countries throughout the publication years of reviewed articles. Numerous, socioeconomic and behavioural factors were influencing TB treatment adher-ence and lost to follow up. Therefore, well understanding and minimizing of the effect of these associated factors is very important to enhance treatment adherence and follow up completion in developing countries.
Keywords: Tuberculosis treatment, Non-adherence, Lost to follow up, TB patients

Background: Ultrasound can rapidly identify abnormal signs, which in high prevalence settings, are highly suggestive of extra-pulmonary tuberculosis (EPTB). Unfortunately experienced sonographers are often scarce in these settings. Methods: A protocol for focused assessment with sonography for HIV-associated tuberculosis (FASH) which can be used by physicians who are relatively inexperienced in ultrasound was developed. Results: The technique as well as normal and pathological findings are described and the diagnostic and possible therapeutic reasoning explained. The protocol is intended for settings where the prevalence of HIV/TB co-infected patients is high. Conclusion: FASH is suitable for more rapid identification of EPTB even at the peripheral hospital level where other imaging modalities are scarce and most of the HIV and TB care will be delivered in the future.

In Africa, TB-HIV co-infection rates are estimated to be 72%. Within sub-Saharan Africa, 34 countries recently reported patients with newly diagnosed MDR-TB, representing 14% of all emerging multi-drug resistant reports worldwide. In addition, eight African countries reported patients harboring extensively drug-resistant TB. More importantly, sub-Saharan Africa bears unacceptably high TB incidence rates coupled with the highest HIV prevalence rates globally. Occurrence of TB related death and new TB infections persist, with men disproportionately affected. A gradual reduction in TB incidence rates from 1.4% per annum between 2000 to 2017 to 1.9% per annum between 2015 and 2016 has been observed. Of note, eight out of the sixteen high burden African countries showed a sharp decline in TB incidence rates, surpassing the “End TB Strategy” goal of a 4% per annum decline. Additionally, substantial decreases in TB mortality in HIV infected patients in nine of sixteen high TB burden Africa...

The presence of cutaneous miliary tuberculosis in the AIDS era emphasized the importance of having a high index of suspicion for this condition in HIV-positive patients with skin lesions and advanced immunodeficiency. We report a 38 year-old male patient, diagnosed with HIV infection that developed disseminated tuberculosis in chest, abdomen and skin. While pulmonary symptoms improved under antituberculous drugs, skin lesion showed positive cultures for 6 months. He was healed after 12 months of treatment. Keywords: Miliary tuberculosis; AIDS; Tuberculous gumma Background Tuberculosis has become more frequent since the emergence of HIV infection epidemics. Nowadays, there are important challenges, which complicate the management of HIV-TB co-infected patients. Among them, it is emphasized the increase of disseminated and extra-pulmonary tuberculosis forms, the multi-drug resistance and the increase in mortality. Case Report A 38 year-old male patient was diagnosed 6 months ago with ...

Pancreatic tuberculosis (TB) is a relatively rare disease
that can mimic carcinoma, lymphoma, cystic neoplasia,
retroperitoneal tumors, pancreatitis or pseudocysts.
Here, I report the case of a 31-year-old immigrant Bur-
mese woman who exhibited epigastralgia, fever, weight
loss and an epigastric mass. The patient was diagnosed
with pancreatic TB and acquired immunodeficiency syn-
drome, and was treated with antituberculous drugs and
percutaneous catheter drainage without a laparotomy.
The clinical presentation, radiographic investigation and
management of pancreatic TB are summarized in this
paper to emphasize the importance of considering this
rare disease in the differential diagnosis of pancreatic
masses concomitant with human immunodeficiency
virus infection. I also emphasize the need for both his-
topathological and microbiological diagnosis via fine-
needle aspiration.

Tuberculosis is a complex disease that involves biological, genetic, physical, social, political and economic factors. The World Health Organisation estimates that two billion people have been exposed to Mycobacterium tuberculosis and carry a latent infection, while an estimated 10% of these people have an active tuberculosis disease. Antibiotics have moved treatment away from sanatoria, but surveillance of tuberculars continues. The availability of antibiotics has also extended the medical gaze to include people with a latent infection. From people with a latent tuberculosis infection to people with active tuberculosis disease and those with co-infection, this paper examines the constellations of pulmonary citizenship forged by medicalisation, treatment surveillance, and social stigma. While the discovery of antibiotics in the 1950s cemented medicine’s authority over tuberculosis, the process of medicalisation began in the 1870s with the characterisation of the mycobacterium and gained momentum in the 1920s with the production of a vaccine. In addition to a medical condition, tuberculosis fast became a moral category that gave force to norms of hygienic citizenship. In this context, people at-risk of developing the disease but not yet exhibiting symptoms have been encouraged to understand their bodies as a site of necessary sanitation. The differential sorting of groups by diagnostic categories, hygienic imperatives, and stigmatising labels has given rise to contested notions of patient rights and responsibilities. As medicine struggles to retain its authority with the rise of multidrug resistant strains of tuberculosis, the social model offers useful perspectives to examine cultural practices, structural violence, and moral obligations.