Impact of three empirical anti-tuberculosis treatment strategies for people initiating antiretroviral therapy
International Journal of Tuberculosis and Lung Disease
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
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.
anti human immunodeficiency virus agent; tuberculostatic agent; adult; comparative study; epidemiology; female; HIV Infections; human; male; mortality; South Africa; tuberculosis; Adult; Anti-HIV Agents; Antitubercular Agents; Female; HIV Infections; Humans; Male; South Africa; Tuberculosis
674-A-00-08-00007-00, USAID, United States Agency for International Development