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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Comparison of treatment outcomes of new smear-positive pulmonary tuberculosis patients by HIV and antiretroviral status in a TB/HIV clinic, Malawi
PLoS ONE, Volume 8, No. 2, Article e56248, Year 2013
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Description
Background: Smear-positive pulmonary TB is the most infectious form of TB. Previous studies on the effect of HIV and antiretroviral therapy on TB treatment outcomes among these highly infectious patients demonstrated conflicting results, reducing understanding of important issues. Methods: All adult smear-positive pulmonary TB patients diagnosed between 2008 and 2010 in Malawi's largest public, integrated TB/HIV clinic were included in the study to assess treatment outcomes by HIV and antiretroviral therapy status using logistic regression. Results: Of 2,361 new smear-positive pulmonary TB patients, 86% had successful treatment outcome (were cured or completed treatment), 5% died, 6% were lost to follow-up, 1% failed treatment, and 2% transferred-out. Overall HIV prevalence was 56%. After adjusting for gender, age and TB registration year, treatment success was higher among HIV-negative than HIV-positive patients (adjusted odds ratio 1.49; 95% CI: 1.14-1.94). Of 1,275 HIV-infected pulmonary TB patients, 492 (38%) received antiretroviral therapy during the study. Pulmonary TB patients on antiretroviral therapy were more likely to have successful treatment outcomes than those not on ART (adjusted odds ratio: 1.83; 95% CI: 1.29-2.60). Conclusion: HIV co-infection was associated with poor TB treatment outcomes. Despite high HIV prevalence and the integrated TB/HIV setting, only a minority of patients started antiretroviral therapy. Intensified patient education and provider training on the benefits of antiretroviral therapy could increase antiretroviral therapy uptake and improve TB treatment success among these most infectious patients. © 2013 Tweya et al.
Authors & Co-Authors
Tweya, Hannock M.
France, Paris
International Union Against Tuberculosis and Lung Disease
Malawi, Lilongwe
Lighthouse Trust
Feldacker, Caryl
Malawi, Lilongwe
Lighthouse Trust
United States, Seattle
University of Washington
Phiri, Sam John Peter
Malawi, Lilongwe
Lighthouse Trust
Ben-Smith, Anne W.
United States, Pittsburgh
University of Pittsburgh
Fenner, Lukas
Switzerland, Bern
University of Bern
Jahn, Andreas
United States, Seattle
University of Washington
Malawi, Lilongwe
Ministry of Health Malawai
Kalulu, Mike Tikhalenawo
Malawi, Lilongwe
Lighthouse Trust
Weigel, Ralf
Malawi, Lilongwe
Lighthouse Trust
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Kamba, C.
Malawi, Lilongwe
Ministry of Health Malawai
Banda, Rebecca
Malawi, Lilongwe
Lighthouse Trust
Egger, Matthias
Switzerland, Bern
University of Bern
Keiser, Olivia
Switzerland, Bern
University of Bern
Statistics
Citations: 73
Authors: 12
Affiliations: 7
Identifiers
Doi:
10.1371/journal.pone.0056248
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Case-Control Study
Study Locations
Malawi