CROI 2016 Abstract eBook

Abstract Listing

Poster Abstracts

735 Spatiotemporal Distribution of Pediatric Tuberculosis in Central Durban, South Africa Gary Parker 1 ; Natashia Morris 2 ;Thandi Kapwata 2 ; Farina Karim 1 ;Tilagavathy Chinappa 3 ; Fernanda Maruri 4 ; Mahomed-Yunus Moosa 5 ;Timothy R. Sterling 4 ;Yuri F. van der Heijden 4 ; Alex Pym 1 1 KwaZulu-Natal Rsr Inst for TB-HIV, Durban, South Africa; 2 South African Med Rsr Council, Durban, South Africa; 3 eThekwini Municipality, Durban, South Africa; 4 Vanderbilt Univ Sch of Med, Nashville, TN, USA; 5 Univ of KwaZulu-Natal, Durban, South Africa Background: Childhood tuberculosis (TB) is due to recent M. tuberculosis infection, and is regarded as a marker of ongoing transmission. Antiretroviral therapy (ART) in HIV+ persons decreases TB risk. This study was conducted to characterize the spatiotemporal distribution of TB in pediatric cases < 5 years old presenting to the TB clinic in central Durban. We hypothesized that following the introduction of ART there would be changes in the spatiotemporal distribution indicating reduced TB transmission. Methods: Using routinely collected data from the Prince Cyril Zulu Centre for Communicable Diseases (PCZCDC) between 2000 and 2012, we mapped cases of pediatric TB (< 5 years old) in central Durban. Address data enabled street level referencing. Cases were mapped by era (pre-ARV, 2000 – 2005 vs post-ARV, 2006 – 2012) and HIV co-infection status. Results: We georeferenced 557 cases of childhood TB to 313 addresses. Of the 135 cases (28%) with HIV results, 59%were co-infected with HIV. Of all cases 93% had pulmonary TB. TB cases were identified in all 6 Durban central suburbs, 2 of which had an aggregation of TB cases. Between 2000 and 2005, 217 TB cases were mapped to 154 addresses, 36 of which had multiple TB cases. Between 2006 and 2012, 340 TB cases were mapped to 225 addresses, 62 of which had multiple TB cases. HIV co-infected patients were identified at 21 addresses in the pre-ARV era and 53 addresses in the post-ARV era. Conclusions: We present evidence of increased pediatric TB cases at specific geographic locations, as well as multiple cases of TB at single addresses in central Durban. An understanding of the spatial distribution of TB data will inform targeted interventions to more effectively control ongoing TB transmission. An increase in TB cases post-ART was not consistent with our hypothesis. The etiology behind the apparent increase in multiple TB cases per address between eras is unclear, but suggests ongoing transmission and warrants further investigation.

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Does ART Increase Infectiousness of Smear-Positive Pulmonary Tuberculosis? Palwasha Y. Khan 1 ; Katharina Kranzer 2 ; Katherine L. Fielding 2 ;Themba Mzembe 3 ; Nimrod Mwaungulu 3 ; Olivier Koole 2 ; Judith Glynn 2 ; Amelia Crampin 2 1 London Sch of Hygiene & Trop Med, Cardiff, UK; 2 London Sch of Hygiene & Trop Med, London, UK; 3 Karonga Prevention Study, Karonga, Malawi Background: Since the roll-out of antiretroviral treatment (ART) in high HIV/TB burden settings, there have been concerns that ART may increase the infectiousness of tuberculosis in HIV-positive patients by shifting the clinical manifestation of disease to be more similar to HIV-negative patients. In patients stable on ART for more than one year, enough immune recovery may have occurred for them to be more “similar” to HIV-negative individuals. We examine the effect of long-term ART on the prevalence of MTB infection among child contacts of adult smear-positive tuberculosis cases. Methods: A cross-sectional household contact study of smear-positive tuberculosis index cases was conducted in Karonga, Malawi in January 2013-April 2015. Prevalence of tuberculin skin test (TST) positivity was compared between household contacts aged <11 years of HIV-negative, HIV-positive not on ART or HIV-positive on ART <1 year, and HIV-positive on ART for ≥1 year (at tuberculosis diagnosis) index cases. A positive TST was defined as ≥10mm. Data on risk factors for MTB infection were collected using a questionnaire, and analysed using a random effects logistic regression model to account for clustering within household. Results: 416 child contacts (167 index cases), of whom 336 had a TST reading (81%; 150 index cases). Index case HIV/ART status was missing for 20 contacts (6%; 9 index cases). The proportion of index cases with the highest grade of smear-positivity (3+), was 45% (36/80), 39% (9/23), and 45% (17/38) in HIV-negative, HIV-positive on ART ≥1 year, and HIV-positive not on ART or on ART for <1 year respectively. The odds of a positive TST were 2.7 times higher in the contacts of HIV-negative index cases (81/182; aOR 2.7: 95% CI 1.1 – 6.7) and similar for HIV-positive index cases who had been on ART for ≥ 1year (12/58; aOR 0.9: 95% CI 0.3 – 2.9), compared to contacts of HIV-positive index cases not on ART or on ART for <1 year (18/76). Conclusions: We found an increased prevalence of MTB infection among child contacts of HIV-negative tuberculosis patients compared to contacts of HIV-positive index cases, irrespective of ART status. We found no evidence that HIV-positive index cases on ART for ≥ 1 year at tuberculosis diagnosis were more likely to transmit than other HIV-positive index cases.

Poster Abstracts

306

CROI 2016