BackgroundPeople who survive tuberculosis continue to experience clinical and societal consequences after recovery, including increased risks of recurrent tuberculosis, premature death, reduced lung function, and ongoing stigma. We aimed to describe the magnitude of this issue by estimating the number of tuberculosis survivors, who could be amenable to intervention. MethodsWe estimated the number of people who developed tuberculosis during 1980-2019 and survived until 2020. Numbers surviving treatment were based on country-level data on tuberculosis case notifications reported to the World Health Organization (WHO), excluding people who died during treatment. Numbers surviving untreated tuberculosis were based on the difference between WHO country-level incidence estimates and notifications, with published age-and HIV-stratified case fatality ratios applied. Post-tuberculosis life tables were developed for each country-year, using United Nations World Population Prospects 2019 mortality rates and published post-tuberculosis mortality hazard ratios. FindingsBetween 1980 and 2019 we estimate that 363 (95% uncertainty interval [UI] 287 -438) million people developed tuberculosis, of whom 172 (95%UI 169 -174) million were treated. Individuals who developed tuberculosis since 1980 experienced a total of 3.5 (95%UI 3.0 -3.9) billion life-years post-tuberculosis, with survivors of paediatric tuberculosis contributing 12% (95%UI 7 -17%) of these life-years. We estimate that 155 (95%UI 138 -171) million tuberculosis survivors were alive in 2020. The South-East Asia region had the largest proportion of tuberculosis survivors (47%). We estimate that 27 (95%UI 26 -29) million tuberculosis survivors alive in 2020 were treated within the past 5 years. InterpretationThe number of tuberculosis survivors alive today is over ten times the estimated annual tuberculosis incidence. Interventions to alleviate respiratory morbidity, screen for and prevent recurrent tuberculosis, and reduce stigma should be immediately prioritised for recently treated tuberculosis survivors.
Policies recommending contact investigation and preventive therapy for contacts are widespread, but policy gaps exist in the areas of ensuring accountability and the management of vulnerable populations such as people living with HIV and those exposed to drug-resistant TB.
Objectives: Describe the causes of death among infants and children less than 5 years stratified by HIV status.Design: Cross-sectional analysis of causes of death ascertained through minimally invasive tissue sampling (MITS) in the Kenya Child Health and Mortality Prevention Surveillance site. Methods:We included decedents aged 28 days to less than 5 years, whose death was reported within 36 h, underwent MITS, and had HIV test results and causes of death determined. MITS specimens were tested using Taqman Array Cards, culture, cytology, histopathology and immunohistochemistry and HIV PCR. A panel evaluated epidemiologic, clinical, verbal autopsy and laboratory data to assign causes of death using ICD-10 guidelines. Causes of death and etiological agents were stratified by HIV status.Results: Of 176 included decedents, 14% (n ¼ 25) were HIV-infected, median viral load was 112 205 copies/ml [interquartile range (IQR) ¼ 9349-2 670 143). HIV-disease (96%; n ¼ 24) and malnutrition (23%; n ¼ 34) were the leading underlying causes of death in HIV-infected and HIV-uninfected decedents, respectively. Malnutrition was more frequent in the causal chain of HIV-infected (56%; n ¼ 14) than HIV-uninfected decedents (31%; n ¼ 49) (P value ¼ 0.03). Viral pneumonia was twice as common in HIV-infected (50%; n ¼ 9) than HIV-uninfected decedents (22%; n ¼ 7) (P value ¼ 0.04). Conclusion:Nearly all HIV-infected decedents' underlying cause of death was HIV disease, which was associated with malnutrition. Our findings underscore the need for strengthening early identification and management of HIV-infected children. Prevention, early diagnosis and treatment of malnutrition could be instrumental in improving the survival of HIV-infected and HIV-uninfected children.
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