Mortality and loss to follow-up among tuberculosis and HIV co-infected patients in rural southwestern Uganda

Abstract

In Uganda, TB-HIV patients present with severe immune suppression and are at increased risk of death and loss to follow-up, particularly those not on ART. There is need for early identification and improved follow-up of TB-HIV co-infected patients.

The Impact of Antiretroviral Therapy on Mortality in HIV Positive People during Tuberculosis Treatment: A Systematic Review and Meta-Analysis

“…The majority of the studies were conducted in the African (n = 11, 52%) [14], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32] and South-East Asian (n = 7, 33%) [33], [34], [35], [36], [37], [38], [39] regions; two studies were conducted in South America [40], [41] and one in Europe [42]. Four out of seven studies in the South-East Asian region were conducted in Thailand [33], [35], [37], [38] while one used data from eighteen sites in the Asia-Pacific region [39].…”

“…More than half of included studies (n = 13, 62%) described a retrospective cohort [23], [24], [25], [27], [34], [37], [40], [42], seven (33.3%) described prospective cohort studies [14], [26], [33], [35], [38], [41] and one was a clinical trial [36]. We excluded seven papers [5], [6], [7], [8], [9], [43], [44] reporting results from large trials that focused on time of ART initiation during TB treatment as TB mortality data was only reported at time points that lay beyond our pre-specified ‘during treatment’ period [6], [7], [43], [44], the outcome was death combined with AIDS-defining illness and mortality data could not be extrapolated [7] or focused only on tuberculous meningitis [9].…”

“…Study enrollment periods ranged from 4 months [30] to 8 years [40]. The majority of the studies were conducted predominantly in urban settings (n = 14, 66.7%) [12], [23], [24], [25], [26], [29], [30], [31], [32], [36], [40], [41], [42]. Table 2 shows the levels of quality assigned to each study.…”

“…Eleven studies reported that a proportion of their patients initiated ART before TB treatment (between 18 and 66%, Table 1), but the actual ART start dates were not reported [24], [26], [28], [29], [30], [33], [34], [38], [39], [41], [42]. Where all patients were initiated on ART during TB treatment, the median start times occurred in month 2 or 3 after starting TB treatment [14], [25], [27], [32], [36], [37].…”

“…In six (29%) studies, data on CD4 count were not reported at all [24], [27], [30], [32], [34], [40]; in four (19%) studies they were not available for the subgroup of the study population included in the meta-analysis [14], [33], [38], [41]; and in five (24%) studies the percentage of the study population included in the meta-analysis for which some measures of CD4 count were available did not exceed 55% [23], [26], [28], [37], [42]. Median CD4 count was available for >98% of subjects included in the meta-analysis in four (19%) studies [31], [35], [36], [39] and ranged from 48 to 152 cells/mm 3 .…”