Department of Epidemiology, University of North Carolina, 2104F McGavran Greenberg Hall, Chapel Hill, NC, United States; Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa; Right to Care, Johannesburg, South Africa
Van Rie, A., Department of Epidemiology, University of North Carolina, 2104F McGavran Greenberg Hall, Chapel Hill, NC, United States; Westreich, D., Department of Epidemiology, University of North Carolina, 2104F McGavran Greenberg Hall, Chapel Hill, NC, United States; Sanne, I., Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa, Right to Care, Johannesburg, South Africa
BACKGROUND: Early mortality in people initiating antiretroviral treatment (ART) remains high. Empirical anti-tuberculosis treatment strategies aim to reduce early mortality by initiating anti-tuberculosis treatment in individuals at high risk of death from undiagnosed TB.METHODS: Using data from 16 913 individuals starting ART under program conditions, we simulated the impact of three empirical treatment strategies (two clinical trials and a pragmatic approach), assuming that 50% of early deaths and 100% of incident TB are averted in those eligible.RESULTS: Compared to starting anti-tuberculosis treatment on clinical or mycobacteriological grounds, 4.4- 31.4% more individuals were eligible for anti-tuberculosis treatment, 5.5-25.4% of deaths were averted and 10.9-57.3% of incident TB cases were prevented under empirical anti-tuberculosis treatment strategies. The proportion receiving any anti-tuberculosis treatment during the first 6 months of ART increased from the observed 24.0% to an estimated 27.5%, 40.4% and 51.3%, under the PrOMPT, REMEMBER and pragmatic approach, respectively.CONCLUSION: The impact of empirical anti-tuberculosis treatment strategies depends greatly on the eligibility criteria chosen. The additional strain placed on anti-tuberculosis treatment facilities and the relatively limited impact of some empirical TB strategies raise the question as to whether the benefits will outweigh the risks at population level. © 2014 The Union.