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A new health care index predicts short term mortality for TB and HIV co-infected people

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  • A O Roen
  • D Podlekareva
  • R F Miller
  • A Mocroft
  • A Panteleev
  • A Skrahina
  • J M Miro
  • J A Cayla
  • S Tetradov
  • E Derisova
  • H Furrer
  • M H Losso
  • A Vassilenko
  • E Girardi
  • J D Lundgren
  • F A Post
  • O Kirk
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BACKGROUND: Using 2004-2007 TB:HIV Study data<x/> from Europe and Latin America, we previously generated a health care index (HCI) for TB and HIV co-infected people. With improvements in diagnostic and management practices, we have now updated the HCI with new data.METHODS: We evaluated nine aspects of health care in Cox proportional hazards models on time from TB diagnosis to death. Kaplan-Meier methods were used to estimate the probability of death by HCI quartile.RESULTS: Of 1396 eligible individuals (72% male, 59% from Eastern Europe), 269 died within 12 months. Use of rifamycin/isoniazid/pyrazinamide-based treatment (HR 0.67, 95% CI 0.50-0.89), TB drug susceptibility testing (DST) and number of active TB drugs (DST + <3 drugs (HR 1.09, 95% CI 0.80-1.48), DST + ≥3 drugs (HR 0.49, 95% CI 0.35-0.70) vs. no DST), recent HIV-RNA measurement (HR 0.64, 95% CI 0.50-0.82) and combination antiretroviral therapy use (HR 0.72, 95% CI 0.53-0.97) were associated with mortality. These factors contributed respectively 5, -1, 8, 5 and 4 to the HCI<x/>. Lower HCI was associated with an increased probability of death; 30% (95% CI 26-35) vs. 9% (95% CI 6-13) in the lowest vs. the highest quartile.<x/>CONCLUSION: We found five potentially modifiable health care components that were associated with mortality among TB-HIV positive individuals. Validation of our HCI in other TB cohorts could enhance our findings.

Original languageEnglish
JournalThe international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
Volume24
Issue number9
Pages (from-to)956-962
Number of pages7
ISSN1027-3719
DOIs
Publication statusPublished - 1 Sep 2020

ID: 61228760