CHAPTER  ONE

INTRODUCTION

1.1 Background to the study

Tuberculosis (TB) is a chronic airborne infectious disease caused by the bacillus Mycobacterium tuberculosis (MTB). According to a World Health Organization (WHO) 2016 report, MTB remains a major public health problem, ranking above HIV/AIDS. It is one of the leading causes of morbidity and mortality among infectious diseases worldwide WHO, (2016). The best estimate of TB deaths in 2015 was 4 million, with an additional 0.4 million deaths resulting from TB disease among HIV-positive people. In terms of cases, there were 10.4 million new TB cases, of which 5.9 million were men, 3.5 million women, and 1 million children detected. Cases that remain undetected continue to suffer from TB disease and also transmit the disease to their contacts Morrison, Pai, Hopewell, (2008).

Tuberculosis/Human immunodeficiency virus (TB/HIV) co-infection has been a common phenomenon for decades, causing a substantially high morbidity and mortality with Tuberculosis ranking as the most common opportunistic infection and the most common cause of mortality among people living with HIV/AIDS (PLWHA) especially in resource restricted countries Manosuthi W et al, (2008) Corbett EL et al., (2003). In the year 2013 alone about 1.1 million new cases of TB were reported in HIV positive patients glob-ally where Majority of them (up to 78%) occurred in Africa WHO, (2014). Tuberculosis occurs as the first manifestation of HIV/AIDS in more than 50% of HIV positive patients WHO, (2004) and deaths that are linked to TB are significantly high especially in sub-Saharan Africa where in some countries this rate is reported to be in excess of 50% WHO, (2011).

Early initiation of Antiretroviral therapy (ART) in the course of TB treatment has been shown to have a mortality benefit and WHO strongly recommends on co-treatment of HIV/TB co-infection, with a rapid scaling up of Antiretro-viral therapy programs especially in resource restricted coun-tries, where tuberculosis is for the most part the widespread opportunistic disease. Lawn SD, Torok ME, Wood R., (2011) In these areas thus ART is regularly initiated when patients are being treated for tuberculosis, with a goal line being to provide an effective and safe Antiretroviral therapy and anti-tuberculosis management which is efficient enough to cure and prevent recurrence and resistance Friedland G et al., (2006).

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