Tuberculosis in Barcelona, Spain (1987-1995). Influence of human immunodeficiency virus and control measures

BACKGROUND: TO study the epidemiology of tuberculosis (TB) in Barcelona, Sp ain from 1987 to 1995, analyzing the influence of HIV infection and the imp act of control measures. PATIENTS, MATERIAL AND METHODS: All cases detected by the Barcelona Tubercu losis Prevention and Control Program were included in the study of the evol ution of TB incidence according to different variables. The impact of HIV i nfection was analyzed through the attributable risk per cent (AR), and cont rol measures through the evolution of the rate of treatment compliance, con tact studies, and diagnostic delay. RESULTS: We detected 8,942 patients, 23.2% of whom were found through the a ctive epidemiological surveillance system, representing an average annual i ncidence of 60.4/100,000. The incidence peaked in 1991 (68.7/100,000) and s lowly declined to 55.7/100,000 in 1995. Men showed higher incidence (RR: 2. 74; CI 95%: 2.62-2.87), particularly among the young (25-34 years olds), 53 .3% of whom were HIV (+). The AR for HIV was 92.7%. In this period there wa s an increase in TB HIV (+), IVDU, and prisoners. Treatment compliance (80. 8% in 1987 to 93.8% in 1995) and contact studies (3.2 studies/case in 1995) evolved favorably, unlike but diagnostic delay (35 days in 1995) did not. CONCLUSIONS: The Active Epidemiological Surveillance System has affored us a clear view of the actual situation regarding TB in Barcelona, Spain. Desp ite the HIV epidemics and the high number of IVDU, the evolution of TB has shown a steady decline due to improvement in control measures.