1. Increasing Tuberculosis Prevalence in South African Township Associated With Increasing HIV Prevalence Slideset on: Lawn SD, Bekker LG, Middelkoop K, Myer L, Wood R. Impact of HIV infection on the epidemiology of tuberculosis in a peri-urban community in South Africa: the need for age- specific interventions. Clin Infect Dis. 2006;42:1040-1047.

2. clinicaloptions.com/hiv Increasing Tuberculosis Prevalence in South African Township Lawn SD, et al. Clin Infect Dis. 2006;42:1040-1047. Background and Rationale  Incidence of tuberculosis substantially increasing in many sub-Saharan countries –27% of world tuberculosis cases concentrated in Africa  Increased prevalence of tuberculosis observed in populations affected by HIV infection and vice versa –Interaction not well-defined in urban, periurban communities in sub-Saharan Africa  Current study assessed age- and sex-specific trends in tuberculosis prevalence and correlation with increasing prevalence of HIV infection from 1996-2004 in periurban township in South Africa

3. clinicaloptions.com/hiv Increasing Tuberculosis Prevalence in South African Township Lawn SD, et al. Clin Infect Dis. 2006;42:1040-1047. Summary of Study Design  Periurban township outside Cape Town, South Africa –Population ~13,000 ; 88% < 39 years of age –Nearly 100% African; > 50% unemployed –Served by single government-run primary health care clinic  Data from community tuberculosis clinic register, census: –Tuberculosis incidence, diagnosis, history –Sputum test findings –Demographic information  Community HIV data derived from several sources

4. clinicaloptions.com/hiv Increasing Tuberculosis Prevalence in South African Township Lawn SD, et al. Clin Infect Dis. 2006;42:1040-1047. Increasing Tuberculosis Incidence  Annual diagnosis rate increased 2.5-fold from 1996-2004; 968 total cases diagnosed from 1996-2004  Rate of TB diagnoses among individuals in 2004: –HIV infected vs uninfected: 4381 vs 656 per 100,000 person-years  HIV infection diagnosed in 87% of patients cured then retreated for subsequent tuberculosis episode (n = 31)  Classification of tuberculosis changing over time: –Pulmonary sputum-negative and extrapulmonary TB increasing more rapidly

5. clinicaloptions.com/hiv Increasing Tuberculosis Prevalence in South African Township Lawn SD, et al. Clin Infect Dis. 2006;42:1040-1047. Demographics of Tuberculosis Diagnoses Age Stratum, Yrs Tuberculosis Diagnosis Rate, Cases/100,000 Person-Years 1996-19972003-2004 0-9582731 10-190436 20-292451369 30-397062599 40-4914052824 50-5917081856  Median age at diagnosis decreased from 43 years in 1996 to 32 years in 2004 (P <.001)

6. clinicaloptions.com/hiv Increasing Tuberculosis Prevalence in South African Township Lawn SD, et al. Clin Infect Dis. 2006;42:1040-1047. Tuberculosis Diagnoses and HIV Prevalence Year Tuberculosis Diagnosis Rate per 1% Inrease in HIV Prevalence, Cases/100,000 Person-Years 1996-1997Baseline 1998-199954.7 2000-200167.3 2002-200377.8 200480.6  Increase in tuberculosis diagnosis rate amplified in association with increase in HIV prevalence

7. clinicaloptions.com/hiv Increasing Tuberculosis Prevalence in South African Township Lawn SD, et al. Clin Infect Dis. 2006;42:1040-1047. Key Conclusions  Annual tuberculosis diagnosis rate in periurban township in South Africa increased 2.5-fold from 1996-2004 –Trend mirrored increasing prevalence of HIV infection  Increased rates of diagnosis concentrated among in individuals 20-39 years of age –Median age of patients diagnosed with tuberculosis decreased from 43 years in 1996 to 32 years in 2004