Morbidity and mortality up to 5 years post tuberculosis treatment in South Africa: A pilot study

Abstract

Background: A high risk of tuberculosis (TB), chronic lung disease, and mortality have been reported among people with a history of previous TB treatment, but data from high-incidence settings remain limited. The aim of this study was to characterize general morbidity and mortality among adults who had successfully completed TB treatment in the past 5 years in a high-incidence setting in South Africa. Methods: Adults (18 years) who had completed treatment for pulmonary TB between 2013 and 2017 were randomly selected from TB treatment registers. Household visits were conducted to locate and interview former TB (FTB) patients, and bacteriological testing for TB was offered. Additional data sources were used to ascertain the vitality status of FTB patients who could not be located. Results: Addresses were located for 200 of the 223 FTB patients sampled and 89 FTB patients were contacted of whom 51 agreed to be interviewed. Approximately half reported persistent respiratory symptoms, such as shortness of breath and wheezing, and repeated lung infections. One (3.6%) of 28 patients who provided a sputum sample had culture-positive TB and another two were currently on re-treatment for TB. Fifteen deaths post treatment were ascertained, resulting in a standardized mortality ratio of 3.8 (95% confidence interval 2.3-6.3) after successful TB treatment relative to the general population. Conclusions: In this high-incidence setting, locating and interviewing FTB patients was challenging. The study findings are consistent with a high rate of respiratory disease, including recurrent TB, and substantially elevated mortality among FTB patients.

Opportunities from a new disease for an old threat: Extending COVID-19 efforts to address tuberculosis in South Africa

“…[25] For this reason, former TB patients, of whom there are many in SA (10/1 000 population), are also a vulnerable group. [26,27] Recent data from Western Cape Province show that people with active TB were over 2.5 times more likely to die of COVID-19 than people without TB (adjusted hazard ratio (aHR) 2.70; 95% confidence interval (CI) 1.81 -4.04), and that people with a previous history of TB had a slightly increased risk of death from COVID-19 (aHR 1.41; 95% CI 1.18 -1.93). [25] Given that HIV was also shown to be associated with COVID-19 mortality (aHR 2.14; 95% CI 1.70 -2.70), the vulnerability of TB and former TB patients will be exacerbated in those co-infected with HIV and those with comorbidities such as diabetes mellitus and hypertension.…”

Airflow obstruction and small airway dysfunction following pulmonary tuberculosis: a cross-sectional survey

“…There is also some evidence that pulmonary TB is related to persistent symptoms and has a substantial adverse impact on quality of life. A high burden of self-reported symptoms after TB treatment completion has been reported 11–13. Better understanding and addressing of airflow obstruction and respiratory symptoms after TB is needed: this is most relevant in low-resource, high-burden settings, where healthcare resources and diagnostic modalities are limited.…”

‘TB is a disease whichhidesin the body’: Qualitative data on conceptualisations of tuberculosis recurrence among patients in Zambia and South Africa

“…Most relapse occurs within the first year after treatment completion and reinfection after the first year likely equally common in high burden settings (Marx et al, 2014). Former TB patients are also at increased risk of long-term negative effects of TB disease, like chronic obstructive pulmonary disorder, bronchiectasis and overall poor lung health (Cohen et al, 2019;Osman et al, 2019). Part of the World Health Organisation's (WHO) strategy for 2020, is to prevent any catastrophic costs to people and their households as a result of TB disease (WHO, 2019).…”