Factors associated with hospitalization and death among TB/HIV co-infected persons in Porto Alegre, Brazil

Abstract

In locations with a high rate of tuberculosis (TB) and HIV infection, there are a number of strategies to prevent negative outcomes such as opportunistic infections, hospitalizations and death, and this article investigates risk factors for the occurrence of hospitalization and death in cases of TB/HIV co-infection in the south of Brazil. The data are taken from a population-based retrospective cohort study on cases of TB/HIV co-infection from 2009 to 2013 in Porto Alegre, Brazil. Sociodemographic, epidemiological and clinical variables were analyzed. Relative risk (RR) estimates for hospitalization and death were determined by regression models. There were 2,419 co-infection cases, of which 1,527 (63.1%) corresponded to hospitalizations, and 662 (27.4%) to death. The occurrence of hospitalization was associated with ≤ 7 years of schooling (RR = 3.47, 95%CI: 1.97–6.29), 8–11 years of schooling (RR = 2.56, 95%CI: 1.44–4.69), place of origin—district health authorities Northwest/Humaitá/Navegantes/Ilhas (RR = 2.01, 95%CI: 1.44–2.82), type of entry into the surveillance system as in cases of reentry after withdrawal (RR = 1,35, 95%CI: 1.07–1.70), closure in surveillance as in withdrawal of treatment (RR = 1.47, 95%CI: 1.18–1.83) and multidrug-resistant tuberculosis (RR = 3.94, 95%CI: 1.97–8.81). The occurrence of death was associated with age (RR = 1.07, 95%CI: 1,01–1,14), ≤ 7 years of schooling (RR = 3.94, 95%CI: 2.26–7.09), 8–11 years of schooling (RR = 2.84, 95%CI: 1.61–5.16), place of origin—district health authorities Baltazar (RR = 2.05, 95%CI: 1.48–2.86), type of entry in the surveillance system as cases of re-entry after withdrawal (RR = 1.53, 95%CI: 1.22–1.91), relapse (RR = 1.33, 95%CI: 1.03–1.73). The occurrence of hospitalizations and deaths is high among co-infected patients. Our estimation approach is important in order to identify, from the surveillance data, the risk factors for hospitalization and death in co-infected patients, so that they may receive more attention from the Brazilian national healthcare system.

Determinants associated with areas with higher tuberculosis mortality rates: an ecological study

“…Mean TB incidence rate, percentage of HIV testing among those diagnosed with TB, the proportion of the population aged 18 years or more without complete primary education and in informal occupations, and the proportion of the population living in urban households without waste collection are related to areas with a high mortality rate due to tuberculosis. These results are consistent with previous studies . TB presents a good approximation of social determinants of a municipality or country, since it is influenced by the processes of social reproduction; therefore, it worries health authorities around the world .…”

Caracterização dos óbitos e dos itinerários terapêuticos investigados pelo Comitê Municipal de Mortalidade por Aids de Porto Alegre em 2015

“…20 Even though there are variations among leading causes of death, tuberculosis is the most frequent condition among individuals with HIV, despite being a manageable clinical event and deaths attributed to it being avoidable through health actions that strengthen timely diagnosis and adequate treatment. 4,23 The high frequency of individuals with a history of abusive use of alcohol and/or drugs in the population studied recalls a characteristics of the HIV epidemic in Porto Alegre where, during the 1990s, more than a third of AIDS cases were related to injecting drug use. 25 With regard to this aspect of HIV transmission, use of drugs prior to death was found in 47.1% of the subjects of the study conducted in Uruguay mentioned above.…”

“…23 A retrospective cohort study analyzed 2,419 cases of this form of coinfection in Porto Alegre between 2009 and 2013 and found hospitalization and mortality frequencies of 63.1% and 27.4%, respectively. 4 Tuberculosis is a death risk factor for people with HIV/AIDS. 20,24 In this study, tuberculosis was followed by pneumonia and septicemia.…”

“…People with HIV/tuberculosis coinfection, history of alcohol and/or drug abuse and people with recent HIV diagnosis need differentiated care from health services, given that they are at greater risk of dying. 4,16,20,24 Nevertheless, in Porto Alegre, weakening of the Municipal Sexually Transmitted Infections and HIV/AIDS Program, low Primary Healthcare coverage, articulation difficulties between HIV and tuberculosis care services and hospital care profile can be seen. 18,26,27 Analysis of the therapeutic itineraries highlighted health service and health worker difficulties in identifying and retaining individuals in HIV/AIDS treatment.…”

“…2 The endemic HIV/AIDS hotspot in Porto Alegre has peculiar characteristics, including late access to diagnosis and treatment, inequities in access to health services 3 and the impact of tuberculosis coinfection. 4 In this context, the absence of accurate information on morbidity and mortality is a relevant obstacle to monitoring and evaluating local responses, in addition to preventing strategies from being prepared to reduce avoidable AIDS-related deaths.…”