Linking HIV-Infected TB Patients to Cotrimoxazole Prophylaxis and Antiretroviral Treatment in India

被引:20
|
作者
Raizada, Neeraj
Chauhan, Lakbir Singh
Babu, B. Sai
Thakur, Rahul
Khera, Ajay
Wares, D. Fraser
Sahu, Suvanand
Bachani, D.
Rewari, B. B.
Dewan, Puneet K.
机构
[1] Office of the WHO Representative to India, New Delhi
[2] Central Tuberculosis Division, Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi
[3] Department of Health, State Government of Andhra Pradesh, Hyderabad
[4] National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi
[5] World Health Organization, Southeast Asia Regional Office, New Delhi
来源
PLOS ONE | 2009年 / 4卷 / 06期
关键词
D O I
10.1371/journal.pone.0005999
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background: HIV-infected persons suffering from tuberculosis experience high mortality. No programmatic studies from India have documented the delivery of mortality-reducing interventions, such as cotrimoxazole prophylactic treatment (CPT) and antiretroviral treatment (ART). To guide TB-HIV policy in India we studied the effectiveness of delivering CPT and ART to HIV-infected persons treated for tuberculosis in three districts in Andhra Pradesh, India, and evaluated factors associated with death. Methods and Findings: We retrospectively abstracted data for all HIV-infected tuberculosis patients diagnosed from March 2007 through August 2007 using standard treatment outcome definitions. 734 HIV-infected tuberculosis patients were identified; 493 (67%) were males and 569 (80%) were between the ages of 24-44 years. 710 (97%) initiated CPT, and 351 (50%) collected >60% of their monthly cotrimoxazole pouches provided throughout TB treatment. Access to ART was documented in 380 (51%) patients. Overall 130 (17%) patients died during TB treatment. Patients receiving ART were less likely to die (adjusted hazard ratio [HR] 0.4, 95% confidence interval [CI] 0.3-0.6), while males and those with pulmonary TB were more likely to die (HR 1.7, 95% CI 1.1-2.7, and HR 1.9, 95% CI 1.1-3.2 respectively). Conclusions: Among HIV-infected TB patients in India death was common despite the availability of free cotrimoxazole locally and ART from referral centres. Death was strongly associated with the absence of ART during TB treatment. To minimize death, programmes should promote high levels of ART uptake and closely monitor progress in implementation.
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页数:7
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