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. 2022 Apr 5;17(4):e0266082.
doi: 10.1371/journal.pone.0266082. eCollection 2022.

Association of HIV infection and antiretroviral therapy with the occurrence of an unfavorable TB treatment outcome in a rural district hospital in Eastern Cape, South Africa: A retrospective cohort study

Brittney J van de Water  1 , Isabel Fulcher  2 , Suretha Cilliers  3 , Nadishani Meyer  3 , Michael Wilson  4 , Catherine Young  5 , Ben Gaunt  3   6 , Karl le Roux  3   6   7
Affiliations

Association of HIV infection and antiretroviral therapy with the occurrence of an unfavorable TB treatment outcome in a rural district hospital in Eastern Cape, South Africa: A retrospective cohort study

Brittney J van de Water et al. PLoS One. .

Abstract

Background: Our objective was to assess differences in TB treatment outcomes between individuals who were HIV negative, HIV positive on anti-retroviral treatment (ART) and HIV positive not on ART, at TB treatment initiation at a rural district hospital in Eastern Cape, South Africa.

Methods: This was a retrospective cohort study of individuals diagnosed with TB between January 2017 and April 2020 at a district hospital. Adults 15 years and over with reported HIV status and treatment outcome were included (N = 711). A categorical outcome with three levels was considered: unfavorable, down referral, and success. We report descriptive statistics for the association between HIV and ART status and treatment outcome using Chi-square and Fisher's exact tests. A multinomial baseline logit model was used to estimate odds ratios for treatment outcomes.

Results: Overall, 59% of included patients were HIV positive with 75% on ART. Eighty-eight patients 12% had an unfavorable outcome. Half of all patients were down referred with an additional 37% having a successful outcome. Individuals without HIV were more likely to be down referred (versus unfavorable) compared to individuals with untreated HIV (2.90 OR, 1.36, 6.17 95% CI). There was a greater likelihood for individuals without HIV having a successful TB treatment outcome compared to individuals with untreated HIV (4.98 OR, 2.07, 11.25 95% CI).

Conclusion: The majority of individuals had positive TB treatment outcomes (down referred or success). However, people without HIV had nearly five times greater odds of having successful outcomes than those with untreated HIV.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Population flowchart.
Fig 2
Fig 2. TB treatment outcomes by age group (N = 936).
See this image and copyright information in PMC

References

    1. World Health Organization. Global Tuberculosis Report. Geneva: WHO; 2019.
    1. South Africa Department of Health. National Strategic Plan on HIV, STIs and TB 2012 2016. In: Council SANA, editor. South Africa, 2012. p. 84.
    1. UNAIDS. 90-90-90 treatment for all Geneva: UNAIDS; 2020. [Available from: https://www.unaids.org/en/resources/909090.
    1. South African National Department of Health TB Programme. The First National TB Prevalence Survey. In: Programme T, editor. Pretoria, 2018. p. 28.
    1. South Africa National Department of Health. Let Our Actions Count: South Africa’s National Strategic Plan for HIV, TB and STIs 2017–2022. Pretoria, 2017.

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