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

被引:27
作者
Nglazi, Mweete D. [1 ,2 ,3 ,4 ]
Bekker, Linda-Gail [1 ,2 ]
Wood, Robin [1 ,2 ]
Kaplan, Richard [1 ,2 ]
机构
[1] Univ Cape Town, Inst Infect Dis & Mol Med, Desmond Tutu HIV Ctr, Fac Hlth Sci, ZA-7925 Cape Town, South Africa
[2] Univ Cape Town, Fac Hlth Sci, Dept Med, ZA-7925 Cape Town, South Africa
[3] Int Union TB & Lung Dis, Paris, France
[4] South African Med Res Council, Burden Dis Res Unit, Cape Town, South Africa
关键词
Tuberculosis; HIV/AIDS; Treatment outcomes; Integrated TB/HIV care; TB treatment; Antiretroviral therapy; INFECTED PATIENTS; THERAPY; SURVIVAL; MORTALITY;
D O I
10.1186/s12879-015-1275-3
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
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.
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