A population-based case-control study was carried out in Mwanza Region, Tanzania, to determine the relative and population attributable risk of human immunodeficiency virus type 1 (HIV-1) infection for developing active tuberculosis. Cases were 441 consecutively diagnosed patients with tuberculosis (all types), aged 15-54 years. Controls were a representative population sample of 4161 people, drawn in a stratified cluster sample from urban areas, roadside settlements, and rural villages. The HIV-1 prevalence in cases was 23.0% in rural, 32.1% in roadside, and 54.1% in urban areas, while in controls these prevalence were 3.4%, 7.2% and 12.1% respectively. The relative risk (RR) of HIV-1 infection for the development of active tuberculosis was estimated to be 8.3 (95% confidence interval [CI] 6.4-11.0).
According to the study, do you think HIV is associated with TB? Do you think this method could give good findings? What would be your preferred methodology, would you use relative risk or odds ratio? How can we control HIV and TB in our communities? Respond to at least two of the questions.
Your Discussion must be at least 250 words in length, detailing your thoughts and position using references from the readings for support. Also be sure to pose 1-2 well thought out questions from which your colleagues can formulate a response or generate further discussion. Be sure to cite any references using APA format.
1. According to the study, do you think HIV is associated with TB?
Yes, I think HIV is associated with developing active tuberculosis in Mwanza Region, Tanzania. This is because the prevalence of HIV-1 in cases was higher than in controls, and the relative risk(RR) of HIV-1 infection for developing active tuberculosis was 8.3.
According to the textbook,
"When RR > 1
− Risk in exposed > Risk in non-exposed
− Positive association; ? causal" (Kanchanaraksa, 2008, p.13)
In other words, HIV-infected people are more likely to develop TB than non-HIV-infected people, and there is a positive relationship, in other words, the causal relationship between HIV infection and TB development.
2. Do you think this method could give good findings? What would be your preferred methodology, would you use relative risk or odds ratio?
No, I do not think this method could give good findings. Relative risk(RR) is available in cohort studies, but this study is a case-control study. So, I would like to use odds ratios because they can be used in both cohort and case-control studies.
3. How can we control HIV and TB in our communities? Respond to at least two of the questions.
・HIV screening
The HIV-infected persons may spread the infection by having sexual intercourse with partners or an unspecified number of people without realizing they are infected with HIV. HIV screening is the only way to detect HIV infection before AIDS develops. At the same time, HIV screening leads to early detection and prevents the progress to AIDs.
・Education
HIV infection can be prevented by always using a condom during sexual contact, which includes not only intercourse but also simulative acts. Also, if they have a habit of having sexual intercourse directly or indirectly with an unspecified number of people, regular screening is necessary. We can prevent the spread of HIV by properly educating people on these specific interventions and coping strategies.
Questions
・How common is tuberculosis in people with HIV?
・Is the causal relationship between HIV and tuberculosis a well-known fact in your country?
Thank you for reading. (340 words)
References
Kanchanaraksa, S. (2008). Estimating risk [PowerPoint file]. John Hopkins University. Retrieved from https://my.uopeople.edu/pluginfile.php/1635151/mod_book/chapter/380244/Lecture16.pdf
Postscript:
In a case-control study, we cannot measure incidence, because we start with diseased people and non-diseased people; therefore, we cannot calculate relative risk in a case-control study (Boston University, 2017). So, I think we need to use odds ratios because they can be used in both cohort and case-control studies.
References
Boston University. (2017). Case-Control Studies. Overview of Analytic Studies. Retrieved December 14, 2022, from https://sphweb.bumc.bu.edu/otlt/mph-modules/ep/ep713_analyticoverview/ep713_analyticoverview5.html
According to WHO, the BCG vaccine has a very low chance of protecting HIV-infected infants from tuberculosis (2017). On the contrary, the risks of BCG vaccination outweigh the benefits of BCG vaccination, as HIV infection weakens the immune system and increases the risk of developing systemic disseminated BCG infection.
World Health Organization. (2017). Safety of BCG vaccination in immunocompromised individuals. Retrieved December 14, 2022, from https://www.who.int/groups/global-advisory-committee-on-vaccine-safety/topics/bcg-vaccines#:~:text=Use%20of%20BCG%20vaccine%20in%20HIV%2Dinfected%20infants&text=Thus%2C%20BCG%20may%20therefore%20provide,to%20be%20infected%20with%20HIV.
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