High mortality in tuberculosis patients despite HIV interventions in Swaziland

Mchunu, Gugu; Griensven, Johan van; Hinderaker, S. G.; Kizito, Walter; Sikhondze, Welile; Manzi, Marcel; Dlamini, Themba; Harries, Anthony

doi:10.5588/pha.15.0081

Cited by 14 publications

(18 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Since integrated TB-HIV data gathering in the ETR.net in the Free State started only in 2009, it was not possible to measure the effect of ART and varying CD4 count levels on mortality in TB cases for the whole study period. Recent research in Swaziland revealed that high mortality in TB-HIV patients has persisted despite increasing ART coverage in TB patients [24]. A separate study is in process to measure the effect of ART in TB-HIV co-infected cases in the Free State for the years 2009 to 2012.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for mortality in TB patients: a 10-year electronic record review in a South African province

et al. 2017

View full text Add to dashboard Cite

BackgroundSince 1990, reduction of tuberculosis (TB) mortality has been lower in South Africa than in other high-burden countries in Africa. This research investigated the influence of routinely captured demographic and clinical or programme variables on death in TB patients in the Free State Province.MethodsA retrospective review of case information captured in the Electronic TB register (ETR.net) over the years 2003 to 2012 was conducted. Extracted data were subjected to descriptive and logistic regression analyses. The outcome variable was defined as all registered TB cases with ‘died’ as the recorded outcome. The variables associated with increased or decreased odds of dying in TB patients were established. The univariate and adjusted odds ratios (OR and AOR) together with their corresponding 95% confidence intervals (CI) were estimated, taking the clustering effect of the districts into account.ResultsOf the 190,472 TB cases included in the analysis, 30,991 (16.3%) had ‘died’ as the recorded treatment outcome. The proportion of TB patients that died increased from 15.1% in 2003 to 17.8% in 2009, before declining to 15.4% in 2012. The odds of dying was incrementally higher in the older age groups: 8–17 years (AOR: 2.0; CI: 1.5–2.7), 18–49 years (AOR: 5.8; CI: 4.0–8.4), 50–64 years (AOR: 7.7; CI: 4.6–12.7), and ≥65 years (AOR: 14.4; CI: 10.3–20.2). Other factors associated with increased odds of mortality included: HIV co-infection (males – AOR: 2.4; CI: 2.1–2.8; females – AOR: 1.9; CI: 1.7–2.1) or unknown HIV status (males – AOR: 2.8; CI: 2.5–3.1; females – AOR: 2.4; CI: 2.2–2.6), having a negative (AOR: 1.4; CI: 1.3–1.6) or a missing (AOR: 2.1; CI: 1.4–3.2) pre-treatment sputum smear result, and being a retreatment case (AOR: 1.3; CI: 1.2–1.4).ConclusionsAlthough mortality in TB patients in the Free State has been falling since 2009, it remained high at more than 15% in 2012. Appropriately targeted treatment and care for the identified high-risk groups could be considered.

show abstract

Section: Discussionmentioning

confidence: 99%

Risk factors for mortality in TB patients: a 10-year electronic record review in a South African province

et al. 2017

View full text Add to dashboard Cite

show abstract

“…This partial integration model of HIV service in the National TB control program was tested in Swaziland and Cambodia; in these countries there was a high coverage of co-trimoxazole preventive therapy (CPT) and ART uptake in TB/HIV patients. 38,39 In Malawi, TB treatment is provided at TB offices and HIV testing is performed at the separate HIV voluntary counseling and testing (VCT) units based in the hospital. HIV-infected patients with TB are then referred to the ART clinic for staging.…”

Section: Towards Implementing Tb and Hiv Collaborative Service Reseamentioning

confidence: 99%

Health systems in the Republic of Congo: challenges and opportunities for implementing tuberculosis and HIV collaborative service, research, and training activities

Linguissi

Gwom

Nkenfou

et al. 2017

International Journal of Infectious Diseases

View full text Add to dashboard Cite

The Republic of Congo is on the World Health Organization (WHO) list of 'high burden' countries for tuberculosis (TB) and HIV. TB is the leading cause of death among HIV-infected patients in the Republic of Congo. In this viewpoint, the available data on TB and HIV in the Republic of Congo are reviewed, and the gaps and bottlenecks that the National TB Control Program (NTCP) faces are discussed. Furthermore, priority requirements for developing and implementing TB and HIV collaborative service activities are identified. HIV and TB control programs operate as distinct entities with separate case management plans. The implementation of collaborative TB/HIV activities to evaluate and monitor the management of TB/HIV co-infected individuals remains inefficient in most regions, and these activities are sometimes non-existent. This reveals major challenges that require definition in order to improve the delivery of healthcare. The NTCP lacks adequate resources for optimal implementation of control measures of TB and HIV compliance and outcomes. The importance of aligning and integrating TB and HIV treatment services (including follow-up) and adherence support services through coordinated and collaborative efforts between individual TB and HIV programs is discussed. Aligning and integrating TB and HIV treatment services through coordinated and collaborative efforts between individual TB and HIV programs is required. However, the WHO recommendations are generic, and health services in the Republic of Congo need to tailor their TB and HIV programs according to the availability of resources and operational feasibility. This will also open opportunities for synergizing collaborative TB/HIV research and training activities, which should be prioritized by the donors supporting the TB/HIV programs.

show abstract

“…The Ministry of Health supported by Médecins Sans Frontières (MSF) provided free ambulatory HIV and TB care (diagnosis, treatment initiation and treatment follow‐up) at three secondary health facilities and integrated it into 22 nurse‐led mobile doctor‐supported primary care clinics from 2009 to 2010. A description of changes in TB programing can be found elsewhere . In summary, the Stop‐TB strategy was adopted in 2009 and comprised intensified TB screening, introduction of infection control measures and provision of isoniazid preventive therapy (in 2012).…”

Section: Methodsmentioning

confidence: 99%

Decreased risk of HIV‐associated TB during antiretroviral therapy expansion in rural Eswatini from 2009 to 2016: a cohort and population‐based analysis

Kerschberger

Schomaker

Telnov

et al. 2019

Tropical Med Int Health

View full text Add to dashboard Cite

Objectives This paper assesses patient‐ and population‐level trends in TB notifications during rapid expansion of antiretroviral therapy in Eswatini which has an extremely high incidence of both TB and HIV. Methods Patient‐ and population‐level predictors and rates of HIV‐associated TB were examined in the Shiselweni region in Eswatini from 2009 to 2016. Annual population‐level denominators obtained from projected census data and prevalence estimates obtained from population‐based surveys were combined with individual‐level TB treatment data. Patient‐ and population‐level predictors of HIV‐associated TB were assessed with multivariate logistic and multivariate negative binomial regression models. Results Of 11 328 TB cases, 71.4% were HIV co‐infected and 51.8% were women. TB notifications decreased fivefold between 2009 and 2016, from 1341 to 269 cases per 100 000 person‐years. The decline was sixfold in PLHIV vs. threefold in the HIV‐negative population. Main patient‐level predictors of HIV‐associated TB were recurrent TB treatment (adjusted odds ratio [aOR] 1.40, 95% confidence interval [CI]: 1.19–1.65), negative (aOR 1.31, 1.15–1.49) and missing (aOR 1.30, 1.11–1.53) bacteriological status and diagnosis at secondary healthcare level (aOR 1.18, 1.06–1.33). Compared with 2009, the probability of TB decreased for all years from 2011 (aOR 0.69, 0.58–0.83) to 2016 (aOR 0.54, 0.43–0.69). The most pronounced population‐level predictor of TB was HIV‐positive status (adjusted incidence risk ratio 19.47, 14.89–25.46). Conclusions This high HIV‐TB prevalence setting experienced a rapid decline in TB notifications, most pronounced in PLHIV. Achievements in HIV‐TB programming were likely contributing factors.

show abstract

High mortality in tuberculosis patients despite HIV interventions in Swaziland

Cited by 14 publications

References 18 publications

Risk factors for mortality in TB patients: a 10-year electronic record review in a South African province

Risk factors for mortality in TB patients: a 10-year electronic record review in a South African province

Health systems in the Republic of Congo: challenges and opportunities for implementing tuberculosis and HIV collaborative service, research, and training activities

Decreased risk of HIV‐associated TB during antiretroviral therapy expansion in rural Eswatini from 2009 to 2016: a cohort and population‐based analysis

Contact Info

Product

Resources

About