scholarly journals Mortality among adults living with HIV treated for tuberculosis based on positive, negative, or no bacteriologic test results for tuberculosis: the IeDEA consortium

2019 ◽  
Author(s):  
John M Humphrey ◽  
Philani Mpofu ◽  
April C. Pettit ◽  
Beverly Musick ◽  
E. Jane Carter ◽  
...  
Keyword(s):  
West Africa ◽  
Treatment Initiation ◽  
People Living With Hiv ◽  
Test Results ◽  
Resource Constrained ◽  
Tb Treatment ◽  
Cox Proportional Hazard ◽  
Observational Cohort ◽  
Facility Level ◽  
Living With Hiv

AbstractBackgroundIn resource-constrained settings, people living with HIV (PLWH) treated for tuberculosis (TB) despite negative bacteriologic tests have a higher mortality than those treated with positive tests. Many PLWH are treated without bacteriologic testing; their mortality compared to those with bacteriologic testing is uncertain.MethodsWe conducted an observational cohort study among PLWH ≥ 15 years of age who initiated TB treatment at clinical sites affiliated with four regions of the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium from 2012-2014: Caribbean, Central and South America, and Central, East, and West Africa. The primary exposure of interest was the TB bacteriologic test status at TB treatment initiation: positive, negative, or no test result. The hazard for death in the 12 months following TB treatment initiation was estimated using the Cox proportional hazard model, adjusted for patient- and site-level factors. Missing covariates were multiply imputed.ResultsAmong 2,091 PLWH included, the median age at TB treatment initiation was 36 years, 44% were female, 53% had CD4 counts ≤ 200 cells/mm3, and 52% were on antiretroviral treatment (ART). Compared to patients with positive bacteriologic tests, the adjusted hazard for death was higher among patients with no test results (HR 1.56, 95% CI 1.08-2.26) but not different than those with negative tests (HR 1.28, 95% CI 0.91-1.81). Older age was also associated with a higher hazard for death, while being on ART, having a higher CD4 count, West Africa region, and tertiary facility level were associated with lower hazards for death.ConclusionPLWH treated for TB with no bacteriologic test results were more likely to die than those treated with positive tests, underscoring the importance of TB bacteriologic diagnosis in resource-constrained settings. Research is needed to understand the causes of death among PLWH treated for TB in the absence of positive bacteriologic tests.

scholarly journals Mortality Among People With HIV Treated for Tuberculosis Based on Positive, Negative, or No Bacteriologic Test Results for Tuberculosis: The IeDEA Consortium

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
John M Humphrey ◽  
Philani Mpofu ◽  
April C Pettit ◽  
Beverly Musick ◽  
E Jane Carter ◽  
...  
Keyword(s):  
Treatment Initiation ◽  
Proportional Hazard ◽  
Test Results ◽  
Risk Of Death ◽  
Tb Treatment ◽  
Cox Proportional Hazard ◽  
Observational Cohort ◽  
Facility Level ◽  
International Epidemiology ◽  
Lower Hazard

Abstract Background In resource-constrained settings, many people with HIV (PWH) are treated for tuberculosis (TB) without bacteriologic testing. Their mortality compared with those with bacteriologic testing is uncertain. Methods We conducted an observational cohort study among PWH ≥15 years of age initiating TB treatment at sites affiliated with 4 International epidemiology Databases to Evaluate AIDS consortium regions from 2012 to 2014: Caribbean, Central and South America, and Central, East, and West Africa. The exposure of interest was the TB bacteriologic test status at TB treatment initiation: positive, negative, or no test result. The hazard of death in the 12 months after TB treatment initiation was estimated using a Cox proportional hazard model. Missing covariate values were multiply imputed. Results In 2091 PWH, median age 36 years, 53% had CD4 counts ≤200 cells/mm3, and 52% were on antiretroviral therapy (ART) at TB treatment initiation. The adjusted hazard of death was higher in patients with no test compared with those with positive test results (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.08–2.26). The hazard of death was also higher among those with negative compared with positive tests but was not statistically significant (HR, 1.28; 95% CI, 0.91–1.81). Being on ART, having a higher CD4 count, and tertiary facility level were associated with a lower hazard for death. Conclusions There was some evidence that PWH treated for TB with no bacteriologic test results were at higher risk of death than those with positive tests. Research is needed to understand the causes of death in PWH treated for TB without bacteriologic testing.

scholarly journals Gaps in tuberculosis control in Armenia: How to improve the care system?

2020 ◽  
Vol 14 (11.1) ◽  
pp. 133S-139S
Author(s):  
Hayk Davtyan ◽  
Ani Petrosyan ◽  
Garry Aslanyan ◽  
Seda Aghabekyan ◽  
Deborah De Basso ◽  
...  
Keyword(s):  
Scientific Evidence ◽  
Treatment Success ◽  
Treatment Guideline ◽  
Public Health Problem ◽  
People Living With Hiv ◽  
Global Public Health ◽  
Tb Treatment ◽  
Living With Hiv ◽  
Lost To Follow Up ◽  
Care System

Introduction: Tuberculosis (TB) continues to be a global public health problem. People with weakened immune systems are more vulnerable to TB. It is one of the top 10 causes of death worldwide and is a leading cause of death for people living with HIV (PLWH). The aim of the current study was to perform programmatic data analysis of TB cases treated with the first-line drugs, registered in Armenia for the period of January 2017 – August 2018, and to identify gaps in TB care system in Armenia. Methodology: A retrospective cohort study using programmatic data from National TB Program. Results: Overall treatment success rate for the period of study was 79%. HIV had impact only on “died” outcome with odds ratio (OR) of 20.9. More than a third (34%) of all HIV-positive patients died during TB treatment and 45% of patients who had non-Armenian citizenship were lost to follow-up during the treatment (OR = 3.3). Treatment duration for the 8% of all cases (mainly with brain or bone localization) was > 9 months and lasted up to 500 days. Conclusions: Better collaboration and partial integration of TB and HIV services in Armenia is required. The access to care for non-Armenian citizens needs to be improved. The national TB treatment guideline needs to be updated based on scientific evidence. This study demonstrates that continuous analysis of the available data and tailoring of the system is required to address the needs of key populations and achieve universal care coverage.

scholarly journals Two diseases, same person: moving toward a combined HIV and tuberculosis continuum of care

2018 ◽  
Vol 29 (9) ◽  
pp. 873-883 ◽  
Author(s):  
Reuben Granich ◽  
Somya Gupta
Keyword(s):  
Public Health ◽  
Disease Control ◽  
Treatment Success ◽  
World Health ◽  
People Living With Hiv ◽  
Global Public Health ◽  
Tb Treatment ◽  
Immunodeficiency Virus ◽  
Health Organization ◽  
Living With Hiv

The human immunodeficiency virus (HIV) and Mycobacterium tuberculosis syndemic remains a global public health threat. Separate HIV and tuberculosis (TB) global targets have been set; however, success will depend on achieving combined disease control objectives and care continua. The objective of this study was to review available policy, budgets, and data to reconceptualize TB and HIV disease control objectives by combining HIV and TB care continua. For 22 World Health Organization (WHO) TB and TB/HIV priority countries, we used 2015 data from the HIV90–90–90watch website, UNAIDS AIDSinfo, and WHO 2016 and 2017 Global TB Reports. Global resources available in TB and HIV/TB activities for 2003–2017 were collected from publicly available sources. In 22 high-burden countries, people living with HIV on antiretroviral therapy ranged from 9 to 70%; viral suppression was 38–63%. TB treatment success ranged from 71 to 94% with 14 (81% HIV/TB burden) countries above 80% TB treatment success. From 2003 to 2017, reported global international and domestic resources for HIV-associated TB and TB averaged $2.85 billion per year; the total for 2003–2017 was 43 billion dollars. Reviewing combined HIV and TB targets demonstrate disease control progress and challenges. Using an integrated HIV and TB continuum supports HIV and TB disease control efforts focused on improving both individual and public health.

scholarly journals STADIUM HIV/AIDS DAN TINGKAT STRES: KORELASI KEDUANYA

2021 ◽  
Vol 4 (1) ◽  
pp. 50-56
Author(s):  
Ahmad Ikhlasul Amal ◽  
Retno Setyawati
Keyword(s):  
Sampling Technique ◽  
P Value ◽  
People Living With Hiv ◽  
Test Results ◽  
Physical Problems ◽  
Level I ◽  
Analytic Design ◽  
Living With Hiv ◽  
The Relationship ◽  
Hiv Aids

Background: Infectious diseases that are still of concern to many circles, namely HIV / AIDS. This is confirmed by the reason that there is still an increase in the number of cases. In addition, this disease makes sufferers or people who are often known as people living with HIV / AIDS (PLWHA) experience both physical and psychological problems. The physical problems experienced by PLWHA, of course, depend on the stage of the patient's disease. PLWHA who experience physical problems may experience stress due to their illness. The purpose of this study was to determine the relationship between HIV stage and stress levels. Method: This type of research is a quantitative observational study with a correlation analytic design with consecutive sampling technique. Data collection was carried out by using a questionnaire with the number of respondents as many as 38 people. The data obtained were processed statistically using the Spearmen Rho statistical test. Results: based on the data, it was found that from 38 research respondents, most of them were 20-60 years old (76.3%). The majority of people with HIV / AIDS were male, namely 23 people (60.5%) with most of the occupations of HIV / AIDS sufferers being private (63.2%). Respondents' HIV was at stage II (50%) and III (50%). The level of stress experienced by HIV / AIDS sufferers is quite good, namely: at level I (31.57) and II (68.43). r = -174, p-value = 0.283. Conclusion: there is no correlation between HIV stage and stress level.

scholarly journals Treatment outcomes of drug-resistant tuberculosis in people living with HIV in Odesa province, Ukraine, 2014-2016

2020 ◽  
Vol 14 (11.1) ◽  
pp. 88S-93S
Author(s):  
Svitlana Yesypenko ◽  
Ruzanna Grigoryan ◽  
Yulia Sereda ◽  
Olga Denisuk ◽  
Liana Kovtunovich ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Urban Areas ◽  
Treatment Success ◽  
People Living With Hiv ◽  
Drug Resistant ◽  
Tb Treatment ◽  
Total Prevalence ◽  
The Mean ◽  
Living With Hiv ◽  
Mean Time

Introduction: Odesa province has the highest TB/HIV prevalence in Ukraine, exceeding the total prevalence in the country by 3 times. The objective of this study was to investigate the unfavorable treatment outcomes and associated factors in patient with drug-resistant (DR) TB in people living with HIV (PLH) in Odesa. Methodology: A cohort study with secondary data analysis was conducted among 373 PLH with confirmed pulmonary DR TB for 2014-2016. Results: About 2/3rd of the cohort were males from urban areas. Mean age and CD4 counts were 39 and 203, respectively. The overall treatment success was 44.2% with the most unfavorable treatment outcomes being observed in extensively and pre-extensively drug resistant (XDR and PreXDR) TB. The mean time between the results of GeneXpert (manufactured by Cepehid) and DR TB treatment based on GeneXpert was 1.3 days. However, the mean time between DR TB treatment based on GeneXpert and results of drug susceptibility test (DST) was 37.0 days referring to a late reporting of DST and to a late adjustment of previously prescribed treatment. The factors associated with the treatment unfavorable outcome included XDR and Pre-XDR TB, lack of antiretroviral treatment (ART), contrimoxazole preventive therapy (CPT) and CD4 test. Conclusions: The rate of successful DR TB treatment in PLH in Odesa remains low. The delayed reporting of DST contributes to lack of timely adjusted treatments. XDR and Pre-XDR TB, lack of ART and CPT are associated with unfavorable treatment outcomes. Additional studies would help to understand the temporal relationship between CD4 test and treatment outcomes.

scholarly journals Prevalence of Cryptococcal Antigen and outcomes in people living with HIV in Honduras: A cohort study

2020 ◽  
Author(s):  
Julio C Zuniga-Moya ◽  
Luis Enrique Romero-Reyes ◽  
Emilio Barrueto Saavedra ◽  
Sandra Montoya ◽  
Diana Varela ◽  
...  
Keyword(s):  
Cohort Study ◽  
Central America ◽  
People Living With Hiv ◽  
Cryptococcal Antigen ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Asymptomatic Patients ◽  
High Incidence ◽  
Cox Proportional Hazard Models ◽  
Living With Hiv

Abstract Background Cryptococcal meningitis is a major cause of death among people living with HIV (PLWH). Cryptococcal antigen (CrAg) testing of asymptomatic patients is an important public health measure to reduce mortality in high incidence areas. However, limited data exists on CrAg prevalence in Central America. Methods We conducted a prospective cohort study at the two largest HIV clinics and hospitals in Honduras. CrAg in serum and cerebrospinal fluid was performed in individuals living with HIV who had CD4 ≤ 100 cells/mm 3 between 2017-2018. After CrAg testing, individuals were followed up for 12 months to assess mortality using adjusted cox proportional hazard models. Results A total of 220 PLWH were tested for CrAg of which 12.7% (n=28) tested positive. CrAg prevalence was higher among hospitalized individuals in 40% (n=10 of 25) of the cases. The proportion (35.8%) of individuals taking ART was significantly (p<0.01) lower among those who tested positive for CrAg. Overall mortality among the cohort was 11.4% (n=25 of 220) by 12 months. CrAg-positive cases were at a significantly higher risk of death [aHR: 2.69, 95%: 1.07-6.84] when compared to CrAg-negative participants. Conclusions CrAg prevalence in Honduras was high among PLWH. Moreover, individuals who tested positive for CrAg testing were at a higher risk of death. Systemic CrAg of PLWH with a CD4 ≤ 100 cells/mm 3 should be routinely performed in Central America.

scholarly journals Tuberculosis treatment outcomes among people living with HIV diagnosed using Xpert MTB/RIF versus sputum-smear microscopy in Botswana: a stepped-wedge cluster randomised trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Tefera Agizew ◽  
Violet Chihota ◽  
Sambayawo Nyirenda ◽  
Zegabriel Tedla ◽  
Andrew F. Auld ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Sputum Smear ◽  
Smear Microscopy ◽  
People Living With Hiv ◽  
Sputum Smear Microscopy ◽  
Stepped Wedge ◽  
Empiric Treatment ◽  
Tb Treatment ◽  
Living With Hiv

Abstract Background Xpert® MTB/RIF (Xpert) has high sensitivity for diagnosing tuberculosis (TB) compared to sputum-smear microscopy (smear) and can reduce time-to-diagnosis, time-to-treatment and potentially unfavorable patient-level treatment outcome. Methods People living with HIV (PLHIV) initiating antiretroviral therapy at 22 HIV clinics were enrolled and underwent systematic screening for TB (August 2012–November 2014). GeneXpert instruments were deployed following a stepped-wedge design at 13 centers from October 2012–June 2013. Treatment outcomes classified as an unfavorable outcome (died, treatment failure or loss-to-follow-up) or favorable outcome (cured and treatment completed). To determine outcome, smear was performed at month 5 or 6. Empiric treatment was defined as initiating treatment without/before receiving TB-positive results. Adjusting for intra-facility correlation, we compared patient-level treatment outcomes between patients screened using smear (smear arm)- and Xpert-based algorithms (Xpert arm). Results Among 6041 patients enrolled (smear arm, 1816; Xpert arm, 4225), 256 (199 per 2985 and 57 per 1582 person-years of follow-up in Xpert and smear arms, respectively; adjusted incidence rate ratio, 9.07; 95% confidence interval [CI]: 4.70–17.48; p < 0.001) received TB diagnosis and were treated. TB treatment outcomes were available for 203 patients (79.3%; Xpert, 157; smear, 46). Unfavorable outcomes were reported for 21.7% (10/46) in the smear and 13.4% (21/157) in Xpert arm (adjusted hazard ratio, 1.40; 95% CI: 0.75–2.26; p = 0.268). Compared to smear, in Xpert arm median days from sputum collection to TB treatment was 6 days (interquartile range [IQR] 2–17 versus 22 days [IQR] 3–51), p = 0.005; patients with available sputum test result had microbiologically confirmed TB in 59.0% (102/173) versus 41.9% (18/43), adjusted Odds Ratio [aOR], 2.00, 95% CI: 1.01–3.96, p = 0.048). In smear arm empiric treatment was 68.4% (39/57) versus 48.7% (97/199), aOR, 2.28, 95% CI: 1.24–4.20, p = 0.011), compared to Xpert arm. Conclusions TB treatment outcomes were similar between the smear and Xpert arms. However, compared to the smear arm, more patients in the Xpert arm received a TB diagnosis, had a microbiologically confirmed TB, and had a shorter time-to-treatment, and had a lower empiric treatment. Further research is recommended to identify potential gaps in the Botswana health system and similar settings. Trial registration ClinicalTrials.gov Identifier: NCT02538952. Retrospectively registered on 2 September 2015.

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