Diagnosis of tuberculosis in a high TB-HIV environment using microscopy and culture: The example of Kakiika Prison-Kyamugorani, Mbarara, Uganda

There is growing concern about the high transmission of tuberculosis (TB) in prisons posing a risk to the outside community. There are high levels of overcrowding in the Uganda Prisons Service (UPS) with some prisons accommodating 4 times above their designed capacities. Our objective was to determine the prevalence of active pulmonary tuberculosis among prisoners. In addition we assessed the accuracy and reliability of TB smear microscopy using culture as gold standard and determined TB-HIV co-infection. Using a cross-sectional survey, we enrolled 140 male inmates in Kakiika prison-Kyamugorani, Mbarara. TB diagnosis was performed using direct sputum smear microscopy (DSSM) and culture for mycobacteria. HIV results were obtained from the clinical register with consent from the study participants. The prevalence of active pulmonary MTB was 2.9% based on culture findings. Microscopy had no smear positive results. However, there was no evidence that culture is different from microscopy in this sample (P=0.13). The overall HIV prevalence was 15.7% and TB-HIV co-infection was 25%. TB prevalence in this prison was greater than that of other prisons in Uganda at 0.7% and the general opulation at 0.4%. This is because the social and economic conditions that increase vulnerability to TB also increase vulnerability to criminal behavior and imprisonment. In addition, the high TB burden is due to the high HIV prevalence in prisons. The study recommended the use of a more sensitive technique for TB diagnosis specially in settings where the level of transmission is presumed to be high.Keywords: Culture, Microscopy, Prisons, Tuberculosis, TB/HIV co-infectio

Prevalence of HIV-related thrombocytopenia among clients at Mbarara Regional Referral Hospital, Mbarara, southwestern Uganda

Ivan M Taremwa,1 Winnie R Muyindike,2 Enoch Muwanguzi,1 Yap Boum II,1,3 Bernard Natukunda1 1Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara University of Science and Technology, 2Immune Suppression Syndrome Clinic, Mbarara Regional Referral Hospital, 3Epicentre Mbarara Research Centre, Mbarara, Uganda Aims/objectives: We aimed to determine the prevalence and correlates of thrombocytopenia among people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and to assess occurrence of antiplatelet antibodies, among thrombocytopenic HIV clients at Mbarara Regional Referral Hospital, southwestern Uganda.Materials and methods: This was a retrospective review of hematologic results at enrollment to HIV care from 2005 to 2013. The prevalence and correlates of thrombocytopenia were estimated based on the Immune Suppressed Syndrome (ISS) Clinic electronic database. A cross-sectional study determined the occurrence of antiplatelet antibodies, using the monoclonal antibody-specific immobilization of platelet antigens (MAIPA) technique.Results: We reviewed 15,030 client records. The median age was 35.0 (range 18–78; interquartile range [IQR] 28–42) years, and there were 63.2% (n=9,500) females. The overall prevalence of thrombocytopenia was 17.4% (95% confidence interval [CI]: 16.8%–18.0%). The prevalence of thrombocytopenia was 17.8% (95% CI: 17.1%–18.4%) among antiretroviral therapy (ART)-naïve clients (n=2,675) and was 13.0% (95% CI: 0.3%–21.9%) for clients who were on ART (n=6). The study found a significant association between thrombocytopenia and other cytopenias, CD4 counts, ART, and deteriorating HIV stage (P<0.05). Two of the 40 participants (5.0%) had antiplatelet antibodies.Conclusion: This study has showed a high prevalence of HIV-related thrombocytopenia. Antiplatelet antibodies were found in 5.0% of HIV-infected thrombocytopenic participants. Our study shows a significant association of thrombocytopenia burden in a high-HIV study population (Southwest Uganda); therefore, there is need to monitor platelet counts and initiate platelet transfusion in our blood banking practices, to avert possible risks of bleeding.Keywords: antiplatelet antibodies, cytopenia, AID