Characteristics of adults and children diagnosed with tuberculosis in Lilongwe, Malawi: findings from an integrated HIV/TB clinic

Trop Med Int Health. 2012 Sep;17(9):1108-16. doi: 10.1111/j.1365-3156.2012.03041.x. Epub 2012 Jul 19.


Objectives: To describe initial registration characteristics of adult and paediatric TB patients at a large, public, integrated TB and HIV clinic in Lilongwe, Malawi, between January 2008 and December 2010.

Methods: Routine data on patient with TB category and TB type, stratified by HIV and ART status, were used to explore differences in proportions among TB only, TB/HIV co-infected patients not on ART and TB/HIV co-infected patients on ART using chi-square tests. Trends over time illustrate strengths and weaknesses of integrated service provision.

Results: Among 10 143 adults, HIV ascertainment and ART uptake were high and increased over time. The proportion of relapse was highest among those on ART (5%). The proportion of smear-positive pulmonary TB (PTB) was highest among HIV-negative patients with TB (34.9%); extra-pulmonary TB (EPTB) was lowest among TB only (16.2%). Among 338 children <15 years, EPTB and smear-positive PTB were more common among TB-only patients. Time trends showed significant increases in the proportion of adults with smear-positive PTB and the proportion of adults already on ART before starting TB treatment. However, some co-infected patients still delay ART initiation.

Conclusions: HIV ascertainment and ART uptake among co-infected patients are successful and improving over time. However, delays in ART initiation indicate some weakness linking TB/HIV patients into ART during TB follow-up care. Improved TB diagnostics and screening efforts, especially for paediatric patients, may help improve quality care for co-infected patients. These results may aid efforts to prioritise TB and HIV prevention, education and treatment campaigns for specific populations.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Retroviral Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Coinfection
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology*
  • HIV Seropositivity / drug therapy
  • HIV Seropositivity / epidemiology
  • Humans
  • Infant
  • Malawi / epidemiology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Tuberculosis / diagnosis*
  • Tuberculosis / epidemiology*
  • Young Adult


  • Anti-Retroviral Agents