Effect of HIV-1 infection on tuberculosis and fertility in a large workforce in Kinshasa, Democratic Republic of the Congo

Voluntary Counseling and Testing for HIV in Rural Area of Democratic Republic of the Congo: Knowledge, Attitude, and Practice Survey among Service Users

Aims. To determine the prevalence of HIV, the level of sexual risk for HIV, and determinants of VCT attendance among adult population living in a rural area. Methods. A cross-sectional study was conducted in Mbanza-Ngungu, Democratic Republic of the Congo. An anonymous questionnaire was designed to extract relevant data. Results. In our cohort, 69% were respondents of more than 24 years of age and the single marital status was most represented (64.1%). A high proportion of respondents (90.6%) visited VCT service for requiring information (good acceptability). Positive test for HIV was reported in 9.4% of respondents. In this cohort, 49.6% of respondents had declared themselves to never use condom. In binary analysis, there was association between positive HIV test and age (p = 0.04) and religions (p = 0.02). In this cohort, it was observed that positive HIV test was significantly associated with confidentiality (p = 0.02). However, there was no association between positive HIV test and condom use (p = 0.25), knowledge of VCT (p = 0.81), service requested (p = 0.20), and previous HIV test (p = 0.68). Conclusions. Preventive information for AIDS should be recommended in the population living in rural zone.

TB and HIV in the Central African region: current knowledge and knowledge gaps

PURPOSE

Reliable and comprehensive data on the HIV/AIDS and TB co-pandemics from Central Africa remain scarce. This systematic review provides a comprehensive overview on current and past research activities in the region and provides a basis for future research work to close knowledge gaps.

METHODS

The scientific literature was searched for publications meeting the following search terms: "tuberculosis" or "HIV" or "acquired immunodeficiency syndrome", combined with "Central Africa", or the names of individual countries within the region. Original studies, reviews and case series were included, and a selection of relevant articles was made.

RESULTS

Most research in the field of HIV and TB has been conducted in Cameroon, where the epidemics have been described fairly well. The Democratic Republic of Congo ranked second on the amount of publications, despite the civil wars over the past several decades. Very little has been published on HIV and TB in the other countries, possibly due to the poor infrastructure of health care systems, lack of scientific capacity building or shortage of laboratory equipment.

CONCLUSIONS

Despite the relatively high burden of HIV and TB in the Central African region, the amount of research activities on these topics is limited. A better understanding of the co-epidemics in this region is urgently needed. The occurrence of opportunistic infections, treatment complications and drug resistance in TB and HIV need to be better described; the failure of public health systems needs to be understood, and research infrastructure needs to be developed. Only then will it be possible to turn the tide against the HIV and TB epidemics in this region.

Persistence of high fertility in tropical Africa: the case of the Democratic Republic of the Congo

The article explores how geography, history, and society have shaped childbearing behaviors over the last half-century, and how they are now being reshaped by modernity and the exigencies of urban life, in the democratic Republic of the Congo. The decline of prolonged postpartum abstinence and involuntary childlessness initially raised fertility to high levels (6–7 children per woman). More recently, socioeconomic differentials in fertility have emerged, suggesting that the country may be entering a phase of fertility decline. A full-blown transition, however, seems still a remote prospect. Supported both by cultural traditions and by economic rationality, Congo's people remain largely convinced of the benefits of many children for their own and their kin's security. While an eventual fertility transition may be taken for granted, the article examines the many hurdles, contradictions, and tensions that will have to be overcome to achieve that outcome.

Effects of duration of HIV infection and secondary tuberculosis transmission on tuberculosis incidence in the South African gold mines

BACKGROUND

HIV increases the risk of tuberculosis directly, through immunosuppression, and indirectly, through onward transmission of Mycobacterium tuberculosis from the increased caseload. We assess the contribution of these two mechanisms by time since seroconversion to HIV.

METHODS

The incidence of new pulmonary tuberculosis was estimated in a retrospective cohort study of South African gold miners over 14 years. HIV tests were done in random surveys in 1992-1993, and in clinics. One thousand nine hundred fifty HIV positive men with seroconversion intervals of less than 3 years were identified and linked to medical, demographic and occupational records. They were compared with men who were HIV-negative in a survey, with no later evidence of HIV. Analyses were censored when men were diagnosed with tuberculosis, died or left the mine.

RESULTS

Tuberculosis incidence rose soon after HIV infection, reaching 1.4/100 person-years (95% confidence interval 1.1-1.9) within 2 years, and 10.0/100 person-years (95% confidence interval 6.5-15.5) at 10 or more years. By 11 years from seroconversion, nearly half the men had had tuberculosis. Among 5702 HIV-negative men, tuberculosis incidence was 0.48/100 person-years (95% confidence interval 0.33-0.70) in 1991-1993 and doubled over the period of the study (after adjusting for age). Age-adjusted model estimates suggest that half the increase in tuberculosis incidence by time since HIV infection was attributable to increasing incidence over calendar period--the indirect effect.

CONCLUSION

For the first time, we have shown that the increase in tuberculosis risk by time since seroconversion reflects both direct effects of HIV increasing susceptibility, and indirect effects due to onward transmission. Innovative and sustained public health measures are needed to reduce Mycobacterium tuberculosis transmission.