Sustained high fatality during TB therapy amid rapid decline in TB mortality at population level: A retrospective cohort and ecological analysis from Shiselweni, Eswatini.

Autor: Kerschberger B; Médecins sans Frontières, Mbabane, Eswatini.; Médecins sans Frontières/Ärzte ohne Grenzen, Vienna Evaluation Unit, Vienna, Austria., Vambe D; National TB Control Programme (NTCP), Manzini, Eswatini., Schomaker M; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.; Department of Statistics, Ludwig-Maximilians University Munich, Munich, Germany., Mabhena E; Médecins sans Frontières, Mbabane, Eswatini., Daka M; Médecins sans Frontières, Mbabane, Eswatini., Dlamini T; National TB Control Programme (NTCP), Manzini, Eswatini., Ngwenya S; National TB Control Programme (NTCP), Manzini, Eswatini., Mamba B; National TB Control Programme (NTCP), Manzini, Eswatini., Nxumalo B; National TB Control Programme (NTCP), Manzini, Eswatini., Sibanda J; National TB Control Programme (NTCP), Manzini, Eswatini., Dube S; National TB Control Programme (NTCP), Manzini, Eswatini., Dlamini LM; National TB Control Programme (NTCP), Manzini, Eswatini., Mukooza E; Médecins sans Frontières, Mbabane, Eswatini., Ellman T; Médecins sans Frontières, Cape Town, South Africa., Ciglenecki I; Médecins sans Frontières, Geneva, Switzerland.
Jazyk: angličtina
Zdroj: Tropical medicine & international health : TM & IH [Trop Med Int Health] 2024 Mar; Vol. 29 (3), pp. 192-205. Date of Electronic Publication: 2023 Dec 15.
DOI: 10.1111/tmi.13961
Abstrakt: Objectives: Despite declining TB notifications in Southern Africa, TB-related deaths remain high. We describe patient- and population-level trends in TB-related deaths in Eswatini over a period of 11 years.
Methods: Patient-level (retrospective cohort, from 2009 to 2019) and population-level (ecological analysis, 2009-2017) predictors and rates of TB-related deaths were analysed in HIV-negative and HIV-coinfected first-line TB treatment cases and the population of the Shiselweni region. Patient-level TB treatment data, and population and HIV prevalence estimates were combined to obtain stratified annual mortality rates. Multivariable Poisson regressions models were fitted to identify patient-level and population-level predictors of deaths.
Results: Of 11,883 TB treatment cases, 1302 (11.0%) patients died during treatment: 210/2798 (7.5%) HIV-negative patients, 984/8443 (11.7%) people living with HIV (PLHIV), and 108/642 (16.8%) patients with unknown HIV-status. The treatment case fatality ratio remained above 10% in most years. At patient-level, fatality risk was higher in PLHIV (aRR 1.74, 1.51-2.02), and for older age and extra-pulmonary TB irrespective of HIV-status. For PLHIV, fatality risk was higher for TB retreatment cases (aRR 1.38, 1.18-1.61) and patients without antiretroviral therapy (aRR 1.70, 1.47-1.97). It decreases with increasing higher CD4 strata and the programmatic availability of TB-LAM testing (aRR 0.65, 0.35-0.90). At population-level, mortality rates decreased 6.4-fold (-147/100,000 population) between 2009 (174/100,000) and 2017 (27/100,000), coinciding with a decline in TB treatment cases (2785 in 2009 to 497 in 2017). Although the absolute decline in mortality rates was most pronounced in PLHIV (-826/100,000 vs. HIV-negative: -23/100,000), the relative population-level mortality risk remained higher in PLHIV (aRR 4.68, 3.25-6.72) compared to the HIV-negative population.
Conclusions: TB-related mortality rapidly decreased at population-level and most pronounced in PLHIV. However, case fatality among TB treatment cases remained high. Further strategies to reduce active TB disease and introduce improved TB therapies are warranted.
(© 2023 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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