The HIV epidemice has had a devastating impact on the epidemiology of tuberculosis in many sub-Saharan African countries. Its impact is also reflected in treatment outcome, notably death of patients while on treatment. In the absence of antiretrovrial treatment, some 20% of tuberculosis patients in Malawi died during treatment in 1997. Obviously, this is not a faliure of the national tuberculosis program, yet if its performance is measured by the objective of curing 85% of patients, it will never be able to live up to such expectations. this is not only disastrous for the individual patient, but also for the reputation of the tuberculosis program in the population, and may have a tremendous adverse effect on the morale of the health care staff.
