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Free Content Mortality among tuberculosis patients in the Democratic Republic of Congo

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SETTING: Kinshasa, Democratic Republic of Congo.

OBJECTIVE: To identify programmatic interventions for improved survival in patients receiving treatment for tuberculosis (TB) at primary care clinics.

DESIGN: Retrospective cohort of adult patients initiating anti-tuberculosis treatment between January 2006 and May 2007.

RESULTS: Among 5685 patients, 390 deaths occurred during anti-tuberculosis treatment, of which half (52%) did so during the first 2 months. Patients with smear-negative pulmonary TB were at greater risk of death in the first 2 months of treatment (human immunodeficiency virus [HIV] positive HR 1.49, 95%CI 0.89–2.49; HIV-negative HR 1.77 95%CI 1.06–2.95), but not thereafter. Patients with extra-pulmonary TB were at increased risk of death in the first 2 months of anti-tuberculosis treatment if they were non-HIV-infected (HR 2.42, 95%CI 1.52–3.85), and were half as likely to die during the remainder of treatment (HIV-positive HR 0.46, 95%CI 0.22–0.97; HIV-negative HR 0.47, 95%CI 0.23–0.94). Antiretroviral therapy (ART) reduced the risk of death by an estimated 36% (HR 0.64, 95%CI 0.37–1.11).

CONCLUSION: High mortality in the first months of anti-tuberculosis treatment could be reduced by addressing diagnostic delays, particularly for extra-pulmonary and smear-negative TB cases and, in HIV-infected patients, by initiation of ART soon after starting anti-tuberculosis treatment.

Keywords: HIV; extra-pulmonary TB; smear-negative TB

Document Type: Research Article


Affiliations: 1: Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA 2: School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo 3: National Tuberculosis Programme, Kinshasa, Democratic Republic of Congo

Publication date: September 1, 2012

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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