Mortality during tuberculosis treatment in South Africa using an 8-year analysis of the national tuberculosis treatment register
Date
2021-08
Journal Title
Journal ISSN
Volume Title
Publisher
Nature
Abstract
In 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.
Description
CITATION: Osman, M. et al. 2021. Mortality during tuberculosis treatment in South Africa using an 8-year analysis of the national tuberculosis treatment register. Scientific Reports, 11:15894, doi:10.1038/s41598-021-95331-w.
The original publication is available at https://www.nature.com
The original publication is available at https://www.nature.com
Keywords
Tuberculosis -- Treatment -- South Africa, Communicable diseases -- South Africa, Tuberculosis -- Mortality -- South Africa
Citation
Osman, M. et al. 2021. Mortality during tuberculosis treatment in South Africa using an 8-year analysis of the national tuberculosis treatment register. Scientific Reports, 11:15894, doi:10.1038/s41598-021-95331-w.