Format

Send to

Choose Destination
BMC Infect Dis. 2015 Nov 19;15:536. doi: 10.1186/s12879-015-1275-3.

The impact of HIV status and antiretroviral treatment on TB treatment outcomes of new tuberculosis patients attending co-located TB and ART services in South Africa: a retrospective cohort study.

Author information

1
The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and the Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. mweete.nglazi@mrc.ac.za.
2
International Union against Tuberculosis and Lung Disease, Paris, France. mweete.nglazi@mrc.ac.za.
3
Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Cape Town, South Africa. mweete.nglazi@mrc.ac.za.
4
The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and the Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. linda-gail.bekker@hiv-research.org.za.
5
The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and the Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. robin.wood@hiv-research.org.za.
6
The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and the Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. Richard.Kaplan@hiv-research.org.za.

Abstract

BACKGROUND:

The implementation of collaborative TB-HIV services is challenging. We, therefore, assessed TB treatment outcomes in relation to HIV infection and antiretroviral therapy (ART) among TB patients attending a primary care service with co-located ART and TB clinics in Cape Town, South Africa.

METHODS:

In this retrospective cohort study, all new TB patients aged ≥ 15 years who registered and initiated TB treatment between 1 October 2009 and 30 June 2011 were identified from an electronic database. The effects of HIV-infection and ART on TB treatment outcomes were analysed using a multinomial logistic regression model, in which treatment success was the reference outcome.

RESULTS:

The 797 new TB patients included in the analysis were categorized as follows: HIV- negative, in 325 patients (40.8 %); HIV-positive on ART, in 339 patients (42.5 %) and HIV-positive not on ART, in 133 patients (16.7 %). Overall, bivariate analyses showed no significant difference in death and default rates between HIV-positive TB patients on ART and HIV-negative patients. Statistically significant higher mortality rates were found among HIV-positive patients not on ART compared to HIV-negative patients (unadjusted odds ratio (OR) 3.25; 95 % confidence interval (CI) 1.53-6.91). When multivariate analyses were conducted, the only significant difference between the patient categories on TB treatment outcomes was that HIV-positive TB patients not on ART had significantly higher mortality rates than HIV-negative patients (adjusted OR 4.12; 95 % CI 1.76-9.66). Among HIV-positive TB patients (n = 472), 28.2 % deemed eligible did not initiate ART in spite of the co-location of TB and ART services. When multivariate analyses were restricted to HIV-positive patients in the cohort, we found that being HIV-positive not on ART was associated with higher mortality (adjusted OR 7.12; 95 % CI 2.95-18.47) and higher default rates (adjusted OR 2.27; 95 % CI 1.15-4.47).

CONCLUSIONS:

There was no significant difference in death and default rates between HIV-positive TB patients on ART and HIV negative TB patients. Despite the co-location of services 28.2 % of 472 HIV-positive TB patients deemed eligible did not initiate ART. These patients had a significantly higher death and default rates.

PMID:
26584607
PMCID:
PMC4653912
DOI:
10.1186/s12879-015-1275-3
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center