Abstract:
BACKGROUND : Gauteng Province has the second lowest tuberculosis (TB) incidence rate in South Africa but the
greatest proportion of TB/HIV co-infection, with 68% of TB patients estimated to have HIV. TB treatment outcomes
are well documented at the national and provincial level; however, knowledge gaps remain on how outcomes
differ across detailed age groups.
METHODS : Using data from South Africa’s National Electronic TB Register (ETR), we assessed all-cause mortality and
loss to follow-up (LTFU) among patients initiating treatment for TB between 01/2010 and 12/2015 in the
metropolitan municipalities of Ekurhuleni Metropolitan Municipality and the City of Johannesburg in Gauteng
Province. We excluded patients who were missing age, had known drug-resistance, or transferred into TB care from
sites outside the two metropolitan municipalities. Among patients assigned a treatment outcome, we investigated
the association between age group at treatment initiation and mortality or LTFU (treatment interruption of ≥2
months) within 10 months after treatment initiation using Cox proportional hazard models and present hazard
ratios and Kaplan-Meier survival curves.
RESULTS : We identified 182,890 children (<10 years), young adolescent (10–14), older adolescent (15–19), young
adult (20–24), adult (25–49), and older adult (≥50) TB cases without known drug-resistance. ART coverage among
HIV co-infected patients was highest for young adolescents (64.3%) and lowest for young adults (54.0%) compared
to other age groups (all over 60%). Treatment success exceeded 80% in all age groups (n = 170,017). All-cause
mortality increased with age. Compared to adults, young adults had an increased hazard of LTFU (20–24 vs 25–49
years; aHR 1.43 95% CI: 1.33, 1.54) while children, young adolescents, and older adults had lower hazard of LTFU.
Patients with HIV on ART had a lower risk of LTFU, but greater risk of death when compared to patients without HIV.
CONCLUSIONS : Young adults in urban areas of Gauteng Province experience a disproportionate burden of LTFU and low
coverage of ART among co-infected patients. This group should be targeted for interventions aimed at improving
clinical outcomes and retention in both TB and HIV care.
