Sustained positive impact on tuberculosis treatment outcomes of TB-HIV integrated care in Uganda
METHODS: We included HIV-positive adults who were new TB cases initiated on anti-tuberculosis treatment between 2009 and 2015 during TB-HIV integration. Trends in TB treatment outcomes and TB-associated deaths were analyzed using respectively the χ2 trend test and Kaplan-Meier methods.
RESULTS: The analysis involved 1318 cases: most patients were female (>50%); the median age ranged from 34 to 36 years, and >60% were late presenters (CD4 count <200 cells/μl), with a median CD4 cell count of 100–146 cells/μl at TB diagnosis. TB treatment success (cured or treatment completed) was 67–76%. Loss to follow-up (LTFU) declined systematically from 7% in 2010 to 3.4% in 2015 (P < 0.01). Antiretroviral therapy (ART) initiation during the intensive phase improved from 47% in 2009 to 97% in 2015 (P < 0.01). The mortality rate was >15% over time, and the probability of death at month 2 of anti-tuberculosis treatment was 52% higher among late presenters than in early presenters (13% vs. 6%, P < 0.01).
CONCLUSION: Significant LTFU improvement and prompt ART initiation could be due to well-implemented TB-HIV integration care; however, static TB-associated deaths may be due to late presentation.
Document Type: Research Article
Affiliations: 1: Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda 2: Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, Division of Intramural Research National Institute of Allergy and Infectious Diseases, National Institutes of Health Clinical Center, Bethesda, Maryland, USA 3: Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Publication date: April 1, 2019
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