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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Use of a WHO-recommended algorithm to reduce mortality in seriously ill patients with HIV infection and smear-negative pulmonary tuberculosis in South Africa: An observational cohort study
The Lancet Infectious Diseases, Volume 11, No. 7, Year 2011
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Description
Background: In 2007, WHO released revised recommendations and an algorithm for the diagnosis and treatment of smear-negative pulmonary tuberculosis in seriously ill people living with HIV/AIDS. We aimed to assess the effect of the recommendations on clinical outcome in patients in South Africa. Methods: We enrolled seriously ill patients (aged ≥15 years) with HIV infection and suspected smear-negative pulmonary tuberculosis from three hospitals in KwaZulu-Natal, South Africa. Patients were consecutively enrolled into two cohorts: the first cohort was managed according to standard practice, and the second according to the WHO-recommended algorithm. The primary endpoints were rates of continued stay in hospital at 7 days after admission and survival at 8 weeks after admission. Findings: 338 patients were enrolled in the standard practice cohort between August, 2008, and February, 2009, and 187 were enrolled in the algorithm cohort between March, 2009, and December, 2009. 7 days after hospital admission, 27% (n=50) of patients in the algorithm cohort were still in hospital, compared with 38% (n=130) in the standard practice cohort (rate ratio 0·70, 95% CI 0·53-0·91; p=0·009). 8 weeks after admission, 83% (n=156) of patients in the algorithm cohort were alive, compared with 68% (n=230) in the standard practice cohort (1·23, 1·11-1·35; p=0·0001), with effect modified by hospital location. Interpretation: In seriously ill patients with HIV infection and suspected smear-negative pulmonary tuberculosis, early antituberculosis treatment according to the WHO algorithm could significantly reduce mortality in South Africa. Funding: US President's Emergency Plan for AIDS Relief. © 2011 Elsevier Ltd.
Authors & Co-Authors
Holtz, Timothy H.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Kabera, Gaëtan M. M.
South Africa, Tygerberg
South African Medical Research Council
Mthiyane, Thuli C.P.
South Africa, Tygerberg
South African Medical Research Council
Zingoni, Tainos
South Africa, Johannesburg
St Mary's Hospital
Nadesan, S.
South Africa, Durban
Mccord Hospital
Ross, Douglas S.
South Africa, Johannesburg
St Mary's Hospital
Allen, Jenny
South Africa, Tygerberg
South African Medical Research Council
Chideya, Sekai
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Sunpath, Henry
South Africa, Durban
Mccord Hospital
Rustomjee, Roxana
South Africa, Tygerberg
South African Medical Research Council
Statistics
Citations: 53
Authors: 10
Affiliations: 4
Identifiers
Doi:
10.1016/S1473-3099(11)70057-3
ISSN:
14733099
e-ISSN:
14744457
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
South Africa