Field Nigel, Lim Megan S C, Murray Jill, Dowdeswell Robert J, Glynn Judith R, Sonnenberg Pam
Research Department of Infection and Population Health, University College London, Mortimer Market Centre (off Capper St), London, WC1E6JB, UK.
Centre for Population Health, Burnet Institute, Melbourne, Australia.
BMC Infect Dis. 2014 Dec 21;14:3858. doi: 10.1186/s12879-014-0679-9.
Tuberculosis (TB) mortality remains high across sub-Saharan Africa despite integration of TB and HIV/ART programmes. To inform programme design and service delivery, we estimated mortality by time from starting TB treatment.
Routinely collected data on TB treatment, vital status, and the timing and causes of death, were linked to cardio-respiratory autopsy data, from 1995-2008, from a cohort of male platinum miners in South Africa. Records were expanded into person-months at risk (pm).
4162 TB episodes were registered; 3170 men were treated for the first time and 833 men underwent retreatment. Overall, 509 men died, with a case fatality of 12.2% and mortality rate of 2.0/100 pm. Mortality was highest in the first month after starting TB treatment for first (2.3/100 pm) and retreatment episodes (4.8/100 pm). When stratified by HIV status, case fatality was higher in HIV positive men not on ART (first episode 14.0%; retreatment episode 26.2%) and those on ART (12.0%; 22.0%) than men of negative or unknown HIV status (2.6%; 3.6%). Mortality was also highest in the first month for each of these groups. Mortality risk factors included older age, previous TB, HIV, pulmonary TB, and diagnostic uncertainty. The proportion of deaths attributable to TB was consistently overestimated in clinical records versus cardio-respiratory autopsy.
Programme mortality was highest in those with HIV and during the first month of TB treatment in all groups, and many deaths were not caused by TB. Resource allocation should prioritise TB prevention and accurate earlier diagnosis, recognise the role of HIV, and ensure effective clinical care in the early stages of TB treatment.
尽管结核病（TB）与艾滋病毒/抗逆转录病毒治疗（ART）项目已整合，但撒哈拉以南非洲地区的结核病死亡率仍然很高。为了为项目设计和服务提供提供信息，我们估计了开始结核病治疗后的时间死亡率。
将1995年至2008年期间从南非一组男性铂金矿工中常规收集的结核病治疗、生命状态以及死亡时间和原因的数据与心肺尸检数据相链接。记录扩展为人月风险（pm）。
登记了4162例结核病发作；3170名男性首次接受治疗，833名男性接受复治。总体而言，509名男性死亡，病死率为12.2%，死亡率为2.0/100 pm。首次（2.3/100 pm）和复治发作（4.8/100 pm）开始结核病治疗后的第一个月死亡率最高。按艾滋病毒状态分层时，未接受抗逆转录病毒治疗的艾滋病毒阳性男性（首次发作14.0%；复治发作26.2%）和接受抗逆转录病毒治疗的男性（12.0%；22.0%）的病死率高于艾滋病毒阴性或未知状态的男性（2.6%；3.6%）。这些组中的每一组在第一个月的死亡率也最高。死亡风险因素包括年龄较大、既往结核病、艾滋病毒、肺结核和诊断不确定性。与心肺尸检相比，临床记录中归因于结核病死亡的比例一直被高估。
在所有组中，艾滋病毒感染者以及结核病治疗的第一个月内项目死亡率最高，许多死亡并非由结核病引起。资源分配应优先考虑结核病预防和准确的早期诊断，认识到艾滋病毒的作用，并确保在结核病治疗早期提供有效的临床护理。
