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Risk factors for mortality in smear-negative tuberculosis suspects: a cohort study in Harare, Zimbabwe

MacPherson, Peter ORCID: https://orcid.org/0000-0002-0329-9613, Dimairo, M., Bandason, T., Zezai, A., Munyati, S.S., Butterworth, A.E., Mungofa, S., Rusakaniko, S., Fielding, K., Mason, P.R. and Corbett, E.L. (2011) 'Risk factors for mortality in smear-negative tuberculosis suspects: a cohort study in Harare, Zimbabwe'. International Journal of Tuberculosis and Lung Disease, Vol 15, Issue 10, pp. 1390-1396.

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Abstract

OBJECTIVE: To investigate mortality rates and risk factors for death among smear-negative tuberculosis (TB) suspects. DESIGN: Cohort study nested within a cluster-randomised trial of community-based active case nding. Smearnegative TB suspects were followed for 12 months, with home tracing where necessary. We calculated mortality rates and used regression analysis to investigate the relationship between clinical characteristics and death. RESULTS: Between February 2006 and June 2007, 1195 smear-negative TB suspects were followed for 1136.8 person-years. Human immunode ciency virus (HIV) prevalence was 63.3%. During follow-up, 139 participants died (11.6%) and mortality rates remained high throughout; 119 (16.5%) HIV-positive individuals and 13 (3.1%) HIV-negative individuals died (HR = 5.8, 95%CI 3.3-10.4, P < 0.001). Advanced immunosuppression was the main risk factor for death among HIV-positive participants, with CD4 count < 50 cells/μ l associated with a 13-fold increased risk of death. Antiretroviral treatment (ART) was initiated by only 106 (14.7%), with long delays in accessing care. CONCLUSION: HIV-positive smear-negative TB suspects are at high and sustained risk of death. Current guidelines for the management of HIV-infected TB suspects are limited, and this study adds to evidence that speci c policies are required to promote earlier HIV and TB diagnosis and reduce delays in ART initiation.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.1 Diagnosis
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis
WF Respiratory System > Tuberculosis > WF 250 Immunological aspects
Faculty: Department: Groups (2002 - 2012) > Clinical Group
Digital Object Identifer (DOI): https://doi.org/10.5588/ijtld.11.0056
Depositing User: Martin Chapman
Date Deposited: 13 Aug 2013 15:44
Last Modified: 06 Feb 2018 13:06
URI: http://archive.lstmed.ac.uk/id/eprint/3460

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