Risk factors for mortality among adults registered on the routine drug resistant tuberculosis reporting database in the Eastern Cape Province, South Africa, 2011 to 2013
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Date
Authors
Chingonzoh, Ruvimbo
Manesen, Mohamed R.
Madlavu, Mncedisi J.
Sopiseka, Nokuthula
Nokwe, Miyakazi
Emwerem, Martin
Musekiwa, Alfred
Kuonza, Lazarus R.
Journal Title
Journal ISSN
Volume Title
Publisher
Public Library of Science
Abstract
INTRODUCTION : South Africa is among countries with the highest burden of drug resistant tuberculosis
(DR-TB). The Eastern Cape Province reported the highest MDR-TB mortality rates in South
Africa for the 2010 treatment cohorts. This study aimed to determine risk factors for mortality
among adult patients registered for DR-TB treatment in the province.
METHODS : We conducted a retrospective cohort study of adult patients treated for laboratory confirmed
DR-TB between January 2011 and December 2013. Demographic and clinical characteristics
of the patients were obtained from a web-based electronic database of patients treated
for DR-TB. We applied modified Poisson regression with robust standard errors to identify
risk factors for DR-TB mortality. We also stratified the analyses into multi-drug resistant TB
(MDR-TB) and extensively drug resistant (XDR-TB).
RESULTS : Among 3,729 patients that met the inclusion criteria, 39% (n = 1,445) died. Of the patients
that died, 53% (n = 766) were male, 68% (n = 982) had MDR-TB, 72% (n = 1,038) were HIV
co-infected, and median age was 37 years (Interquartile Range [IQR] 30±46). Patients were
at higher risk of mortality during DR-TB treatment if they were HIV co-infected not on antiretroviral
treatment (ART) (adjusted incidence risk ratio [aIRR] 3.3, 95% confidence interval
[CI] 2.9±3.8), were 60 years or older (aIRR 1.7, 95%CI 1.5±2.0), had a diagnosis of XDR-TB (aIRR 1.6, 95%CI 1.5±1.7), or had been hospitalised at treatment start (aIRR 1.7, 95%CI
1.5±1.8). Among MDR-TB patients, risk of mortality was higher if patients were HIV coinfected
not on ART (aIRR 3.9, 95%CI 3.3±4.6), were 60 years or older (aIRR 1.9, 95%CI
1.6±2.3), or had been hospitalised at start of MDR-TB treatment (aIRR 1.7, 95%CI 1.5±1.9).
Among XDR-TB patients, risk of mortality was higher in patients who were HIV co-infected
not on ART (aIRR 1.8, 95%CI 1.5±2.2), or had been hospitalised at the start of XDR-TB
treatment (aIRR 1.5, 95%CI 1.3±1.8).
CONCLUSION : HIV co-infected not on ART, older age, XDR-TB and hospital admission for DR-TB treatment
were independent risk factors for DR-TB mortality. Integration of TB and HIV services,
with focus on voluntary HIV testing and counselling of DR-TB patients with unknown HIV
status, and provision of ART for all co-infected patients may reduce DR-TB mortality in the
Eastern Cape.
Description
Keywords
Patients, South Africa (SA), Drug resistant tuberculosis (DR-TB), Multi-drug resistant tuberculosis (MDR-TB), Tuberculosis (TB), Antiretroviral treatment (ART), Human immunodeficiency virus (HIV)
Sustainable Development Goals
Citation
Chingonzoh R, Manesen MR, Madlavu
MJ, Sopiseka N, Nokwe M, Emwerem M, et al.
(2018) Risk factors for mortality among adults
registered on the routine drug resistant
tuberculosis reporting database in the Eastern Cape
Province, South Africa, 2011 to 2013. PLoS ONE
13(8): e0202469. https://DOI.org/10.1371/journal.pone.0202469.