Osman, Muhammad ORCID: https://orcid.org/0000-0003-3818-9729, van Schalkwyk, Cari, Naidoo, Pren, Seddon, James A., Dunbar, Rory, Dlamini, Sicelo S., Welte, Alex, Hesseling, Anneke C. and Claassens, Mareli M. (2021) Mortality during tuberculosis treatment in South Africa using an 8-year analysis of the national tuberculosis treatment register. Scientific Reports, 11 (1):15894. ISSN 2045-2322 (Online) (doi:10.1038/s41598-021-95331-w)

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Abstract

n 2011, the South African HIV treatment eligibility criteria were expanded to allow all tuberculosis (TB) patients lifelong ART. The impact of this change on TB mortality in South Africa is not known. We evaluated mortality in all adults (≥ 15 years old) treated for drug-susceptible TB in South Africa between 2009 and 2016. Using a Cox regression model, we quantified risk factors for mortality during TB treatment and present standardised mortality ratios (SMR) stratified by year, age, sex, and HIV status. During the study period, 8.6% (219,618/2,551,058) of adults on TB treatment died. Older age, male sex, previous TB treatment and HIV infection (with or without the use of ART) were associated with increased hazard of mortality. There was a 19% reduction in hazard of mortality amongst all TB patients between 2009 and 2016 (adjusted hazard ratio: 0.81 95%CI 0.80–0.83). The highest SMR was in 15–24-year-old women, more than double that of men (42.3 in 2016). Between 2009 and 2016, the SMR for HIV-positive TB patients increased, from 9.0 to 19.6 in women, and 7.0 to 10.6 in men. In South Africa, case fatality during TB treatment is decreasing and further interventions to address specific risk factors for TB mortality are required. Young women (15–24-year olds) with TB experience a disproportionate burden of mortality and interventions targeting this age-group are needed.

Item Type:	Article
Uncontrolled Keywords:	tuberculosis mortality; tuberculosis programmatic management
Subjects:	H Social Sciences > HA Statistics Q Science > QR Microbiology > QR355 Virology R Medicine > RB Pathology
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified:	23 Mar 2022 15:37
URI:	http://gala.gre.ac.uk/id/eprint/35561

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