Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2022 Oct 12;17(10):e0274549. doi: 10.1371/journal.pone.0274549. eCollection 2022.
Tuberculosis (TB) remains the leading cause of death among human immunodeficiency virus (HIV) infected individuals in South Africa. Despite the implementation of HIV/TB integration services at primary healthcare facility level, the effect of HIV on TB treatment outcomes has not been well investigated. To provide evidence base for TB treatment outcome improvement to meet End TB Strategy goal, we assessed the effect of HIV status on treatment outcomes of TB patients at a rural clinic in the Ugu Health District, South Africa.
We reviewed medical records involving a cohort of 508 TB patients registered for treatment between 1 January 2013 and 31 December 2015 at rural public sector clinic in KwaZulu-Natal province, South Africa. Data were extracted from National TB Programme clinic cards and the TB case registers routinely maintained at study sites. The effect of HIV status on TB treatment outcomes was determined by using multinomial logistic regression. Estimates used were relative risk ratio (RRR) at 95% confidence intervals (95%CI).
A total of 506 patients were included in the analysis. Majority of the patients (88%) were new TB cases, 70% had pulmonary TB and 59% were co-infected with HIV. Most of HIV positive patients were on antiretroviral therapy (ART) (90% (n = 268)). About 82% had successful treatment outcome (cured 39.1% (n = 198) and completed treatment (42.9% (n = 217)), 7% (n = 39) died 0.6% (n = 3) failed treatment, 3.9% (n = 20) defaulted treatment and the rest (6.6% (n = 33)) were transferred out of the facility. Furthermore, HIV positive patients had a higher mortality rate (9.67%) than HIV negative patients (2.91%)". Using completed treatment as reference, HIV positive patients not on ART relative to negative patients were more likely to have unsuccessful outcomes [RRR, 5.41; 95%CI, 2.11-13.86].
When compared between HIV status, HIV positive TB patients were more likely to have unsuccessful treatment outcome in rural primary care. Antiretroviral treatment seems to have had no effect on the likelihood of TB treatment success in rural primary care. The TB mortality rate in HIV positive patients, on the other hand, was higher than in HIV negative patients emphasizing the need for enhanced integrated management of HIV/TB in rural South Africa through active screening of TB among HIV positive individuals and early access to ART among HIV positive TB cases.
在南非，结核病（TB）仍然是艾滋病毒（HIV）感染者死亡的主要原因。尽管在初级保健机构一级实施了艾滋病毒/结核病综合服务，但 HIV 对结核病治疗结果的影响尚未得到充分研究。为了为改善结核病治疗结果提供循证依据，以实现终结结核病战略目标，我们评估了在南非乌古卫生区农村诊所中 HIV 状态对结核病患者治疗结果的影响。
我们回顾了 2013 年 1 月 1 日至 2015 年 12 月 31 日期间在南非夸祖鲁-纳塔尔省农村公立部门诊所登记治疗的 508 例结核病患者的医疗记录。数据从国家结核病规划诊所卡和研究现场常规维护的结核病病例登记册中提取。使用多项逻辑回归确定 HIV 状态对结核病治疗结果的影响。使用的估计值是 95%置信区间（95%CI）的相对风险比（RRR）。
共有 506 例患者纳入分析。大多数患者（88%）为新结核病病例，70%患有肺结核，59%合并感染 HIV。大多数 HIV 阳性患者正在接受抗逆转录病毒治疗（ART）（90%（n=268））。约 82%的患者治疗结果成功（治愈 39.1%（n=198）和完成治疗（42.9%（n=217）），7%（n=39）死亡，0.6%（n=3）治疗失败，3.9%（n=20）失访，其余（6.6%（n=33））转出该机构。此外，HIV 阳性患者的死亡率（9.67%）高于 HIV 阴性患者（2.91%）。“与阴性患者相比，未接受抗逆转录病毒治疗的 HIV 阳性患者完成治疗的可能性较低[RRR，5.41；95%CI，2.11-13.86]。”
与 HIV 状态相比，在农村初级保健中，HIV 阳性结核病患者更有可能出现治疗结果不佳。抗逆转录病毒治疗似乎对农村初级保健中结核病治疗成功的可能性没有影响。另一方面，HIV 阳性患者的结核病死亡率高于 HIV 阴性患者，这强调了需要通过积极筛查 HIV 阳性个体中的结核病并早期为 HIV 阳性结核病患者提供抗逆转录病毒治疗，加强南非农村地区 HIV/TB 的综合管理。
