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    Timing, rates, and causes of death in a large South African tuberculosis programme

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    Author
    Field, N; Lim, MSC; Murray, J; Dowdeswell, RJ; Glynn, JR; Sonnenberg, P
    Date
    2014-12-21
    Source Title
    BMC Infectious Diseases
    Publisher
    BMC
    University of Melbourne Author/s
    Lim, Megan
    Affiliation
    Melbourne School of Population and Global Health
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Field, N., Lim, M. S. C., Murray, J., Dowdeswell, R. J., Glynn, J. R. & Sonnenberg, P. (2014). Timing, rates, and causes of death in a large South African tuberculosis programme. BMC INFECTIOUS DISEASES, 14 (1), https://doi.org/10.1186/s12879-014-0679-9.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/259246
    DOI
    10.1186/s12879-014-0679-9
    Abstract
    BACKGROUND: Tuberculosis (TB) mortality remains high across sub-Saharan Africa despite integration of TB and HIV/ART programmes. To inform programme design and service delivery, we estimated mortality by time from starting TB treatment. METHODS: Routinely collected data on TB treatment, vital status, and the timing and causes of death, were linked to cardio-respiratory autopsy data, from 1995-2008, from a cohort of male platinum miners in South Africa. Records were expanded into person-months at risk (pm). RESULTS: 4162 TB episodes were registered; 3170 men were treated for the first time and 833 men underwent retreatment. Overall, 509 men died, with a case fatality of 12.2% and mortality rate of 2.0/100 pm. Mortality was highest in the first month after starting TB treatment for first (2.3/100 pm) and retreatment episodes (4.8/100 pm). When stratified by HIV status, case fatality was higher in HIV positive men not on ART (first episode 14.0%; retreatment episode 26.2%) and those on ART (12.0%; 22.0%) than men of negative or unknown HIV status (2.6%; 3.6%). Mortality was also highest in the first month for each of these groups. Mortality risk factors included older age, previous TB, HIV, pulmonary TB, and diagnostic uncertainty. The proportion of deaths attributable to TB was consistently overestimated in clinical records versus cardio-respiratory autopsy. CONCLUSIONS: Programme mortality was highest in those with HIV and during the first month of TB treatment in all groups, and many deaths were not caused by TB. Resource allocation should prioritise TB prevention and accurate earlier diagnosis, recognise the role of HIV, and ensure effective clinical care in the early stages of TB treatment.

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