Treatment outcome and its attributes in TB-HIV co-infected patients registered under Revised National TB Control Program: a retrospective cohort analysis

Ambadekar, Nitin N; Zodpey, Sanjay; Soni, Reeni; Lanjewar, S.P.

doi:10.1016/j.puhe.2015.03.006

Cited by 26 publications

(32 citation statements)

References 15 publications

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“…This could result from residual confounding by measured or unmeasured factors, such as treatment adherence, or because patients with both pulmonary and extra-pulmonary disease were classified as pulmonary cases. A univariate analysis of data from the RNTCP on TB-HIV patients, however, reported lower treatment success amongst pulmonary cases (OR 0.58, 95%CI 0.40–0.83),37 consistent with our results.…”

Section: Discussionsupporting

confidence: 91%

“…This has been suggested to be related to HIV prevalence, especially advanced HIV disease, which is associated with low bacillary burden in the sputum 34. While extra-pulmonary TB has been associated with longer treatment delays,35 HIV infection36 and worse outcomes than pulmonary TB,26 higher treatment success among extra-pulmonary patients has also been reported 37. This depends partly on the site of extra-pulmonary disease; for example, meningeal and disseminated TB have higher mortality rates than lymphatic TB 38.…”

Section: Discussionmentioning

confidence: 99%

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Tuberculosis treatment outcomes among disadvantaged patients in India

Jackson

Doshi

Pan

et al. 2017

public health action

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Setting: Urban slums and poor rural areas in India, 2012–2014.Objective: To describe the characteristics of tuberculosis (TB) patients enrolled in treatment through Operation ASHA, a non-governmental organisation serving disadvantaged populations in India, and to identify risk factors for unfavourable treatment outcomes.Design: This was a retrospective cohort study. Patient characteristics were assessed for their relationship with treatment outcomes using mixed effects logistic regression, adjusting for clustering by treatment centre and Indian state. Outcomes were considered favourable (cured/treatment completed) or unfavourable (treatment failure, loss to follow-up, death, switch to multidrug-resistant TB treatment, transfer out).Results: Of 8415 patients, 7148 (84.9%) had a favourable outcome. On multivariable analysis, unfavourable outcomes were more common among men (OR 1.31, 95%CI 1.15–1.51), older patients (OR 1.12, 95%CI 1.04–1.21) and previously treated patients (OR 2.05, 95%CI 1.79–2.36). Compared to pulmonary smear-negative patients, those with extra-pulmonary disease were less likely to have unfavourable outcomes (OR 0.72, 95%CI 0.60–0.87), while smear-positive pulmonary patients were more likely to have unfavourable outcomes (OR 1.38, 95%CI 1.15–1.66 for low [scanty/1+] and OR 1.71, 95%CI 1.44–2.04 for high [2+/3+] positive smears).Conclusion: The treatment success rate within Operation ASHA is comparable to that reported nationally for India. Men, older patients, retreatment cases and smear-positive pulmonary TB patients may need additional interventions to ensure a favourable outcome.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Tuberculosis treatment outcomes among disadvantaged patients in India

Jackson

Doshi

Pan

et al. 2017

public health action

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“…In line with the WHO [19] recommendation that all patients with (presumptive) TB be offered HIV testing, it is encouraging to note that by 2014, there was a substantial improvement in the country as a whole, with 93% of TB patients knowing their HIV status [1]. Similarly to other studies [1, 4–7] we found significant differences in treatment outcomes between patients who were HIV-negative and HIV-positive. Over the four year study period, 24.5% of HIV-negative patients compared to 15.3% of HIV-positive patients had an unsuccessful treatment outcome.…”

Section: Discussionsupporting

confidence: 85%

“…Several studies have found a lower TB treatment success rate among co-infected patients [1, 4–7]. An important intervention that can have a substantial impact on the reduction of mortality and morbidity among co-infected patients is the use of antiretroviral treatment (ART) [1].…”

Section: Introductionmentioning

confidence: 99%

Unsuccessful TB treatment outcomes with a focus on HIV co-infected cases: a cross-sectional retrospective record review in a high-burdened province of South Africa

Engelbrecht

Kigozi

Chikobvu

et al. 2017

BMC Health Serv Res

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BackgroundSouth Africa did not meet the MDG targets to reduce TB prevalence and mortality by 50% by 2015, and the TB cure rate remains below the WHO target of 85%. TB incidence in the country is largely fuelled by the HIV epidemic, and co-infected patients are more likely to have unsuccessful TB treatment outcomes. This paper analyses the demographic and clinical characteristics of new TB patients with unsuccessful treatment outcomes, as well as factors associated with unsuccessful treatment outcomes for HIV co-infected patients.MethodsA cross-sectional retrospective record review of routinely collected data for new TB cases registered in the Free State provincial electronic TB database between 2009 and 2012. The outcome variable, unsuccessful treatment, was defined as cases ≥15 years that ‘died’, ‘failed’ or ‘defaulted’ as the recorded treatment outcome. The data were subjected to descriptive and logistic regression analyses.ResultsFrom 2009 to 2012 there were 66,940 new TB cases among persons ≥15 years (with a recorded TB treatment outcome), of these 61% were co-infected with HIV. Unsuccessful TB treatment outcomes were recorded for 24.5% of co-infected cases and 15.3% of HIV-negative cases. In 2009, co-infected cases were 2.35 times more at risk for an unsuccessful TB treatment outcome (OR: 2.35; CI: 2.06-2.69); this figure decreased to 1.8 times by 2012 (OR: 1.80; CI: 1.63-1.99). Among the co-infected cases, main risk factors for unsuccessful treatment outcomes were: ≥ 65 years (AOR: 1.71; CI: 1.25-2.35); receiving treatment in healthcare facilities in District D (AOR: 1.15; CI 1.05-1.28); and taking CPT (and not ART) (AOR: 1.28; CI: 1.05-1.57). Females (AOR: 0.93; CI: 0.88-0.99) and cases with a CD4 count >350 (AOR: 0.40; CI: 0.36-0.44) were less likely to have an unsuccessful treatment outcome.ConclusionsThe importance of TB-HIV/AIDS treatment integration is evident as co-infected patients on both ART and CPT, and those who have a higher CD4 count are less likely to have an unsuccessful TB treatment outcome. Furthermore, co-infected patients who require more programmatic attention are older people and males.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2406-x) contains supplementary material, which is available to authorized users.

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“…Whereas the former had a cure rate of 71%, the latter had a cure rate of only 50%, which means that patients with tuberculosis-HIV co-infection had a 48% lower chance of cure than did HIV-negative patients. This relationship has been reported in other studies 29 , 30 and is related to the immunodeficiency caused by HIV in such patients, the time from diagnosis to treatment initiation, and the limited access to health care 31 . Even after the launch of the PNCT and after the establishment of the WHO and the Brazilian MS goal of curing 85% of reported cases by 2015, Brazil has not yet achieved this purpose, as shown by our analysis of the 2002-2012 period 1 …”

Section: Discussionsupporting

confidence: 66%

Temporal analysis of reported cases of tuberculosis and of tuberculosis-HIV co-infection in Brazil between 2002 and 2012

Gaspar¹,

Nunes

et al. 2016

J. bras. pneumol.

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Objective: To investigate the reported cases of tuberculosis and of tuberculosis-HIV co-infection in Brazil between 2002 and 2012. Methods: This was an observational study based on secondary time series data collected from the Brazilian Case Registry Database for the 2002-2012 period. The incidence of tuberculosis was stratified by gender, age group, geographical region, and outcome, as was that of tuberculosis-HIV co-infection. Results: Nationally, the incidence of tuberculosis declined by 18%, whereas that of tuberculosis-HIV co-infection increased by 3.8%. There was an overall decrease in the incidence of tuberculosis, despite a significant increase in that of tuberculosis-HIV co-infection in women. The incidence of tuberculosis decreased only in the 0-to 9-year age bracket, remaining stable or increasing in the other age groups. The incidence of tuberculosis-HIV co-infection increased by 209% in the ≥ 60-year age bracket. The incidence of tuberculosis decreased in all geographical regions except the south, whereas that of tuberculosis-HIV co-infection increased by over 150% in the north and northeast. Regarding the outcomes, patients with tuberculosis-HIV coinfection, in comparison with patients infected with tuberculosis only, had a 48% lower chance of cure, a 50% greater risk of treatment nonadherence, and a 94% greater risk of death from tuberculosis. Conclusions: Our study shows that tuberculosis continues to be a relevant public health issue in Brazil, because the goals for the control and cure of the disease have yet to be achieved. In addition, the sharp increase in the incidence of tuberculosis-HIV co-infection in women, in the elderly, and in the northern/northeastern region reveals that the population of HIV-infected individuals is rapidly becoming more female, older, and more impoverished.

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Treatment outcome and its attributes in TB-HIV co-infected patients registered under Revised National TB Control Program: a retrospective cohort analysis

Cited by 26 publications

References 15 publications

Tuberculosis treatment outcomes among disadvantaged patients in India

Tuberculosis treatment outcomes among disadvantaged patients in India

Unsuccessful TB treatment outcomes with a focus on HIV co-infected cases: a cross-sectional retrospective record review in a high-burdened province of South Africa

Temporal analysis of reported cases of tuberculosis and of tuberculosis-HIV co-infection in Brazil between 2002 and 2012

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