Gender difference in mortality among pulmonary tuberculosis HIV co-infected adults aged 15-49 years in Kenya

Abstract

Setting Kenya, 2012–2015 Objective To explore whether there is a gender difference in all-cause mortality among smear positive pulmonary tuberculosis (PTB)/ HIV co-infected patients treated for tuberculosis (TB) between 2012 and 2015 in Kenya. Design Retrospective cohort of 9,026 smear-positive patients aged 15–49 years. All-cause mortality during TB treatment was the outcome of interest. Time to start of antiretroviral therapy (ART) initiation was considered as a proxy for CD4 cell count. Those who took long to start of ART were assumed to have high CD4 cell count. Results Of the 9,026 observations analysed, 4,567(51%) and 4,459(49%) were women and men, respectively. Overall, out of the 9,026 patients, 8,154 (90%) had their treatment outcome as cured, the mean age in years (SD) was 33.3(7.5) and the mean body mass index (SD) was 18.2(3.4). Men were older (30% men’ vs 17% women in those ≥40 years, p = <0.001) and had a lower BMI <18.5 (55.3% men vs 50.6% women, p = <0.001). Men tested later for HIV: 29% (1,317/4,567) of women HIV tested more than 3 months prior to TB treatment, as compared to 20% (912/4,459) men (p<0.001). Mortality was higher in men 11% (471/4,459) compared to women 9% (401/4,567, p = 0.004). There was a 17% reduction in the risk of death among women (adjusted HR 0.83; 95% CI 0.72–0.96; p = 0.013). Survival varied by age-groups, with women having significantly better survival than men, in the age-groups 40 years and over (log-rank p = 0.006). Conclusion Women with sputum positive PTB/HIV co-infection have a significantly lower risk of all-cause mortality during TB treatment compared to men. Men were older, had lower BMI and tested later for HIV than women.

A survival analysis of prognostic determinant factors of time-to-death of HIV/TB co-infected patients under HAART followed-up in a public hospital in Ethiopia

“…The followup period of this study also revealed that there were 29.5% deaths among HIV/TB co-infected patients, which might be comparable with a study of Sanzana [17] and higher and lower than studies of [18][19][20][21][22][23] and [1,16,[24][25][26], respectively. In this study, female patients presented slightly higher survival time than male patients as indicated in the K-M plot of patients, which might show a comparable result with studies of Sanzana [17] and Kosgei et al [27]. The mean and median age of the co-infected patients' were 33.63 and 32 years old, respectively, which implies that youths were the most infected with HIV persons, leading to TB co-infection, since this age represents sexually active stages with a high possibility of unprotected sex or sharing drug injection equipment that are the most common modes of HIV transmission [17,28].…”

Tuberculosis poor treatment outcomes and its determinants in Kilifi County, Kenya: a retrospective cohort study from 2012 to 2019

“…The systematic review included one study from Kenya. However, the included study was limited to smearpositive pulmonary TB patients aged 15 to 49 years only [24]. Another systematic review included 31 studies from Sub-Saharan Africa published from July 2008 to June 2018.…”

Predictors of mortality and survival probability distribution among patients on tuberculosis treatment in Vihiga County, Kenya

“…HIV was also independently associated with increased risk of mortality among patients on TB treatment. Previous studies within Kenya 14 , 17 , 21 and other high TB burden countries including Tanzania 15 , Zimbabwe 22 and South Africa 42 have similarly found HIV to pose a serious mortality risk among TB patients. Predictors of mortality among the HIV positive subgroup included smoking, severe malnutrition, severe illness and comorbidities.…”

“…This is despite rigorous intervention programs such as use of molecular and culture methods for TB diagnosis, use of short-course fixed dose combination drugs, nutritional support, TB/HIV collaboration and routine follow up of patients 12 . Although several studies [13][14][15][16][17] concur on the need for a person-centered interven-tion integrated within a multi-sectoral strategy, there still exists scanty information on reasons for often observed survival distributions and causes of increased risk for mortality among patients on TB treatment. Such infor-mation is useful for more accurate prediction of risks and occurrence of mortality.…”

“…Previous studies have associated TB mortality with female gender 13 , male gender 14 , bacteriological unconfirmed TB, advanced age 15 , comorbidities 16 , 18 , 19 , behavioral characteristics 16 , 20 and HIV 17 , 21 , 22 . However, routine surveillance data may not provide sufficient variables to assess survival probably patterns and analyse the influence of broader demographic, socio-economic and clinical factors on mortality of TB patients 23 , 24 hence may not be applicable to the local setting.…”