Comparison of treatment outcomes of new smear-positive pulmonary tuberculosis patients by HIV and antiretroviral status in a TB/HIV clinic, Malawi

Tweya, H and Feldacker, C and Phiri, S and Ben-Smith, A and Fenner, L and Jahn, A and Kalulu, M and Weigel, R and Kamba, C and Banda, R and Egger, M and Keiser, O (2013) Comparison of treatment outcomes of new smear-positive pulmonary tuberculosis patients by HIV and antiretroviral status in a TB/HIV clinic, Malawi. PLoS ONE, 8 (2).

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Abstract

Background: Smear-positive pulmonary TB is the most infectious form of TB. Previous studies on the effect of HIV and antiretroviral therapy on TB treatment outcomes among these highly infectious patients demonstrated conflicting results, reducing understanding of important issues. Methods: All adult smear-positive pulmonary TB patients diagnosed between 2008 and 2010 in Malawi's largest public, integrated TB/HIV clinic were included in the study to assess treatment outcomes by HIV and antiretroviral therapy status using logistic regression. Results: Of 2,361 new smear-positive pulmonary TB patients, 86% had successful treatment outcome (were cured or completed treatment), 5% died, 6% were lost to follow-up, 1% failed treatment, and 2% transferred-out. Overall HIV prevalence was 56%. After adjusting for gender, age and TB registration year, treatment success was higher among HIV-negative than HIV-positive patients (adjusted odds ratio 1.49; 95% CI: 1.14-1.94). Of 1,275 HIV-infected pulmonary TB patients, 492 (38%) received antiretroviral therapy during the study. Pulmonary TB patients on antiretroviral therapy were more likely to have successful treatment outcomes than those not on ART (adjusted odds ratio: 1.83; 95% CI: 1.29-2.60). Conclusion: HIV co-infection was associated with poor TB treatment outcomes. Despite high HIV prevalence and the integrated TB/HIV setting, only a minority of patients started antiretroviral therapy. Intensified patient education and provider training on the benefits of antiretroviral therapy could increase antiretroviral therapy uptake and improve TB treatment success among these most infectious patients. © 2013 Tweya et al.

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Details

Item Type:	Article
Status:	Published
Creators/Authors:	Creators Email Pitt Username ORCID Tweya, H Feldacker, C Phiri, S Ben-Smith, A Fenner, L Jahn, A Kalulu, M Weigel, R Kamba, C Banda, R Egger, M Keiser, O
Date:	15 February 2013
Date Type:	Publication
Journal or Publication Title:	PLoS ONE
Volume:	8
Number:	2
DOI or Unique Handle:	10.1371/journal.pone.0056248
Schools and Programs:	School of Medicine > Biomedical Informatics
Refereed:	Yes
Other ID:	NLM PMC3574145
PubMed Central ID:	PMC3574145
PubMed ID:	23457534
Date Deposited:	08 Apr 2013 19:01
Last Modified:	20 Dec 2018 00:55
URI:	http://d-scholarship.pitt.edu/id/eprint/17846

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