Tuberculosis and the HIV epidemic: Increasing annual risk of tuberculous infection in Kenya, 1986-1996

Objectives. The purpose of this study was to assess the impact of the incre ased incidence of tuberculosis (TB) due to HIV infection on the risk of TB infection in schoolchildren. Methods. Tuberculin surveys were carried out in randomly selected primary s chools in 12 districts in Kenya during 1986 through 1990 and 1994 through 1 996. Districts were grouped according to the year in which TB notification rates started to increase. HIV prevalence in TB patients and changes in TB infection prevalence were compared between districts. Results. Tuberculous infection prevalence rates increased strongly in distr icts where TB notification rates had increased before 1994 (odds ratio = 3. 1, 95% confidence interval = 2.3, 4.1) but did not increase in districts wh ere notification rates had increased more recently or not at all. HIV preva lence rates in TB patients were 50% in districts with an early increase in notification rates and 28% in the ether study districts. Conclusions. Countries with an increasing prevalence of HN infection will n eed additional resources for TB control, not only for current patients but also for the patients in additional cases arising from the increased risk o f TB infection.