TB checks in HIV care valuable for new mums in South Africa

Health care workers at the Chris Hani Baragwanath Hospital in Soweto, South Africa, have shown that offering routine TB checks for new mothers with HIV (and their male partners) can identify many previously unsuspected cases in need of treatment.

One of the problems with tuberculin skin tests is that they require a repeat clinic visit to assess them. This problem may be reduced when women give birth to a baby in hospital, which may mean a short stay and/or repeat visits and therefore provides an opportunity to check on TB status – their own and, in some cases, also their male partners’.

During a research project now reported as a letter in the journal AIDS, 438 HIV positive patients, 95% of them women, were enrolled between May and November 2001. All participants were given tuberculin skin tests using the Mantoux method, with two units of PPD injected into their skin. 318 returned for their results (though obviously the others may have seen for themselves that their results were negative and acted accordingly).

The 157 patients (49% of 318) who reacted with spots 5mm or more in width after 2-3 days were referred to a TB specialist, given chest radiography and, if there were suggestive symptoms, a physical examination and further tests including sputum culture and biopsies as needed.

Thirteen patients were diagnosed with active TB, nine extrapulmonary and four with culture-positive pulmonary TB. These last four would have posed an immediate risk to their newborn babies, if not detected and treated. The authors point out that some additional cases of active TB may have been missed, since a negative skin test does not conclusively show that TB is absent, especially among HIV positive people with low CD4 counts. Even these 13 cases represent 3% of the whole study population and 11% of those who tested positive on the skin test and returned for their results.

The median CD4 count among the HIV positive patients with a positive skin test result was 230 cells/mm³. This means that while most would not have been eligible for ARV treatment, even if it had been available, they would have been well placed to benefit from isoniazid preventive therapy against TB.

This study clearly shows the value of thinking about TB and HIV health needs in an integrated way and should prompt other service providers to look for similar opportunities to protect their patients' health.