Treatment outcomes among children, adolescents, and adults on treatment for tuberculosis in two metropolitan municipalities in Gauteng Province, South Africa
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Date
Authors
Berry, Kaitlyn M.
Rodriguez, Carly A.
Berhanu, Rebecca H.
Ismail, Nazir Ahmed
Mvusi, Lindiwe
Long, Lawrence
Evans, Denise
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
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.
Description
Keywords
Pediatrics, Adults, Young adults, Tuberculosis (TB), Gauteng Province, South Africa, Electronic TB register (ETR), Loss to follow-up (LTFU), Outcomes, Human immunodeficiency virus (HIV)
Sustainable Development Goals
Citation
Berry, K.M., Rodriguez, C.A., Berhanu, R.H. et al. 2019, 'Treatment outcomes among children,
adolescents, and adults on treatment for
tuberculosis in two metropolitan
municipalities in Gauteng Province, South
Africa', BMC Public Health, vol. 19, art. 973, pp. 1-17.