Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients
Abstract:OBJECTIVES: To assess health care utilisation for patients co-infected with TB and HIV (TB-HIV), and to develop a weighted health care index (HCI) score based on commonly used interventions and compare it with patient outcome.
METHODS: A total of 1061 HIV patients diagnosed with TB in four regions, Central/Northern, Southern and Eastern Europe and Argentina, between January 2004 and December 2006 were enrolled in the TB-HIV study. A weighted HCI score (range 0–5), based on independent prognostic factors identified in multivariable Cox models and the final score, included performance of TB drug susceptibility testing (DST), an initial TB regimen containing a rifamycin, isoniazid and pyrazinamide, and start of combination antiretroviral treatment (cART).
RESULTS: The mean HCI score was highest in Central/Northern Europe (3.2, 95%CI 3.1–3.3) and lowest in Eastern Europe (1.6, 95%CI 1.5–1.7). The cumulative probability of death 1 year after TB diagnosis decreased from 39% (95%CI 31–48) among patients with an HCI score of 0, to 9% (95%CI 6–13) among those with a score of ≥4. In an adjusted Cox model, a 1-unit increase in the HCI score was associated with 27% reduced mortality (relative hazard 0.73, 95%CI 0.64–0.84).
CONCLUSIONS: Our results suggest that DST, standard anti-tuberculosis treatment and early cART may improve outcome for TB-HIV patients. The proposed HCI score provides a tool for future research and monitoring of the management of TB-HIV patients. The highest HCI score may serve as a benchmark to assess TB-HIV management, encouraging continuous health care improvement.
Document Type: Research Article
Affiliations: 1: Copenhagen HIV Programme, University of Copenhagen, Denmark 2: University College London, London, UK 3: King's College London School of Medicine, London, UK 4: TB Hospital #2, St Petersburg, Russia 5: Centre for Sexual Health and HIV Research, University College London, London, UK 6: Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain 7: Centre Inserm U897-Epidemiologie-Biostatistique, Université Bordeaux, Institut de Santé Publique, d'Epidémiologie et de Developpement (ISPED), Bordeaux, France; Centre Inserm U897-Epidemiologie-Biostatistique, Institut National de la Santé et de la Recherche Médicale, ISPED, Bordeaux, France 8: Clinic for Infectious Diseases, Berne University Hospital and University of Berne, Berne, Switzerland 9: Infectology Centre of Latvia, Tuberculosis and Lung Diseases Clinic, Riga, Latvia 10: Instituto Nazionale Malattie Infettive L Spallanzani, Rome, Italy 11: Hospital JM Ramos Mejia, Servicio de Immunocomprometidos, Buenos Aires, Argentina 12: Servicio de Epidemiología, Agencia de Salud Pública de Barcelona, CIBER Epidemiología y Salud Pública, Barcelona, Spain 13: Botkin Hospital of Infectious Diseases, St Petersburg, Russia 14: Rigshospitalet, Copenhagen, Denmark 15: Research Institute of Pulmonology and Pulmonary Tuberculosis, Minsk, Belarus 16: Copenhagen HIV Programme, University of Copenhagen, Denmark; Rigshospitalet, Copenhagen, Denmark 17: Copenhagen HIV Programme, University of Copenhagen, Denmark; and Rigshospitalet, Copenhagen, Denmark
Publication date: February 1, 2013
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.
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