THE COTE-DIVOIRE NATIONAL HIV COUNSELING AND TESTING PROGRAM FOR TUBERCULOSIS PATIENTS - IMPLEMENTATION AND ANALYSIS OF EPIDEMIOLOGIC DATA

Objectives: To describe the implementation of a free, voluntary and co nfidential HIV counseling and testing program for patients with newly diagnosed tuberculosis at the eight large outpatient tuberculosis cent ers in Cote d'Ivoire, and to present epidemiologic findings on partici pating patients. Design: HIV counseling and testing program with ongoi ng HIV serosurveillance. Methods: HIV counseling and testing services were established at the two tuberculosis centers in Abidjan in 1989 an d were extended to six centers in the Cote d'Ivoire interior in the fi rst half of 1994. Characteristics of counseled patients, acceptance ra tes of HIV testing, and HIV serologic results were analyzed for all ei ght centers from 1994 to 1996. Temporal trends in HIV seropositivity r ates were examined for the two centers of Abidjan from 1989 to 1996. R esults: From July 1994 through December 1996, 17 946 (91.8%) out of 19 594 patients who were counseled at the eight centers in Cote d'Ivoire consented to HIV testing, of whom 7749 (43.2%) were HIV-seropositive. The highest rates of 47.0 and 45.6% were found in the two centers in Abidjan, with rates ranging from 32.9 to 42.4% in the six centers in t he interior. HIV-seropositive tuberculosis patients from each of the 5 0 districts in Cote d'Ivoire were identified. In Abidjan, the HIV sero positivity rate remained relatively stable among men (46.7% in 1989, 4 8.5% in 1991, 43.6% in 1996), but rose sharply among women from 32.7% in 1989 to 50.1% in 1996. Conclusions: The high HIV seropositivity rat es among tuberculosis patients in all geographic regions of Cote d'Ivo ire indicate that the HIV epidemic has now spread throughout the count ry. However, the successful implementation of an extensive HIV counsel ing and testing program for more than 37 000 tuberculosis patients to date demonstrates the commitment of the Cote d'Ivoire Ministry of Heal th to integrating HIV/AIDS prevention activities with tuberculosis con trol efforts. When logistically and economically feasible, the extensi on of HIV-related social and clinical services to HIV-seropositive tub erculosis patients should be considered by other national tuberculosis control programs in Africa.