HIV counselling increases condom use in TB patients

TB patients who have knowledge regarding the relationship between TB and HIV or have been counselled on HIV are more likely to report having used a condom during sexual intercourse, according to a study presented at the 2^nd South African TB conference held in Durban last week.

Researchers also reported that unmarried TB patients or those who have completed secondary level education were more likely to report condom use during last sexual encounter.

TB patients are a key group for HIV prevention because of the high rate of HIV co-infection in this group, but the study found that only 334 of the 533 (62.7%) TB patients in the study had been counselled for HIV, despite HIV counselling for all TB patients being part of the South African national guidelines.

In addition, 386 of the 533 (73.5%) had no knowledge of the relationship between TB and HIV. These findings show that activities to strengthen HIV counselling and TB/HIV treatment literacy are necessary for TB patients.

Those who had not been counselled on HIV were half as likely to report condom use at last sexual encounter in comparison to those who had been counselled on HIV (p<0.01).

Those who had been on TB treatment for more than 60 days were 50% more likely to report condom use than those who had been on TB treatment for less than 60 days (p<0.05).

Unmarried patients were twice as likely to use condoms (p<0.01) and patients who had completed secondary schooling were 80% more likely to report condom use when compared to those who had completed primary school or less (p<0.01).

Women who had knowledge of the relationship between TB and HIV were half as likely to have reported condom use. According to researchers this is consistent with the previously reported inability of women to negotiate condom use due to gender inequalities in power within relationships.

The study, by Dr Gladys Kigozi and Dr Christo Heunis from the Centre for Health Systems Research and Development of the University of the Free State, identified factors associated with condom use during most recent sex as reported by TB patients in four sub-districts of the Free State in South Africa.

No prior research about condom use of TB patients in South Africa exists. The TB/HIV co-infection rate among registered TB patients for the Free State province was 60.3% in 2007.

600 TB patients were recruited from February to March 2008 from 61 primary health care facilities in two districts (one urban, one rural) in the Free State.

Patients were recruited when exiting TB consultation rooms, and a structured questionnaire was used to identify if a condom had been used the last time they had had sexual intercourse, serving as a proxy for condom use over prolonged periods of time.

Of the 600 patients, 52 patients indicated that they had never been sexually active, 13 could not remember whether condoms were used at their last sexual encounter, and two refused to respond to this question.

The study was limited by the fact that convenience sampling at the patient level was used.

However, it was found that the sample was not different from the general South African population on key variables such as age and sex. Social desirability bias may also have been present where participants may have provided false information regarding condom use. Attempts were made to reduce this by assuring patients that all information gathered would be treated confidentially.

“Our study show that TB patient categories who should be targeted for more aggressive condom promotion include those who are older, married, less educated and newly initiated on TB treatment,” said Dr Heunis.