Time to ART initiation among patients treated for rifampicin-resistant tuberculosis in Khayelitsha, South Africa: impact on mortality and treatment success

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dc.contributor.authorDaniels, Johnny Flippieen_ZA
dc.contributor.authorKhogali, Mohammeden_ZA
dc.contributor.authorMohr, Erikaen_ZA
dc.contributor.authorCox, Vivianen_ZA
dc.contributor.authorMoyo, Sizuluen_ZA
dc.contributor.authorEdginton, Maryen_ZA
dc.contributor.authorHinderaker, Sven Gudmunden_ZA
dc.contributor.authorMeintjes, Graemeen_ZA
dc.contributor.authorHughes, Jenniferen_ZA
dc.contributor.authorDe Azevedo, Virginiaen_ZA
dc.contributor.authorvan Cutsem, Gillesen_ZA
dc.contributor.authorCox, Helen Suzanneen_ZA
dc.date.accessioned2016-01-02T05:05:43Z
dc.date.available2016-01-02T05:05:43Z
dc.date.issued2015en_ZA
dc.description.abstractSetting Khayelitsha, South Africa, with high burdens of rifampicin-resistant tuberculosis (RR-TB) and HIV co-infection. Objective To describe time to antiretroviral treatment (ART) initiation among HIV-infected RR-TB patients initiating RR-TB treatment and to assess the association between time to ART initiation and treatment outcomes. Design A retrospective cohort study of patients with RR-TB and HIV co-infection not on ART at RR-TB treatment initiation. RESULTS: Of the 696 RR-TB and HIV-infected patients initiated on RR-TB treatment between 2009 and 2013, 303 (44%) were not on ART when RR-TB treatment was initiated. The median CD4 cell count was 126 cells/mm 3 . Overall 257 (85%) patients started ART during RR-TB treatment, 33 (11%) within 2 weeks, 152 (50%) between 2-8 weeks and 72 (24%) after 8 weeks. Of the 46 (15%) who never started ART, 10 (21%) died or stopped RR-TB treatment within 4 weeks and 16 (37%) had at least 4 months of RR-TB treatment. Treatment success and mortality during treatment did not vary by time to ART initiation: treatment success was 41%, 43%, and 50% among patients who started ART within 2 weeks, between 2-8 weeks, and after 8 weeks (p = 0.62), while mortality was 21%, 13% and 15% respectively (p = 0.57). Mortality was associated with never receiving ART (adjusted hazard ratio (aHR) 6.0, CI 2.1-18.1), CD4 count ≤100 (aHR 2.1, CI 1.0-4.5), and multidrug-resistant tuberculosis (MDR-TB) with second-line resistance (aHR 2.5, CI 1.1-5.4). CONCLUSIONS: Despite wide variation in time to ART initiation among RR-TB patients, no differences in mortality or treatment success were observed. However, a significant proportion of patients did not initiate ART despite receiving >4 months of RR-TB treatment. Programmatic priorities should focus on ensuring all patients with RR-TB/HIV co-infection initiate ART regardless of CD4 count, with special attention for patients with CD4 counts ≤ 100 to initiate ART as soon as possible after RR-TB treatment initiation.en_ZA
dc.identifier.apacitationDaniels, J. F., Khogali, M., Mohr, E., Cox, V., Moyo, S., Edginton, M., ... Cox, H. S. (2015). Time to ART initiation among patients treated for rifampicin-resistant tuberculosis in Khayelitsha, South Africa: impact on mortality and treatment success. <i>PLoS One</i>, http://hdl.handle.net/11427/16154en_ZA
dc.identifier.chicagocitationDaniels, Johnny Flippie, Mohammed Khogali, Erika Mohr, Vivian Cox, Sizulu Moyo, Mary Edginton, Sven Gudmund Hinderaker, et al "Time to ART initiation among patients treated for rifampicin-resistant tuberculosis in Khayelitsha, South Africa: impact on mortality and treatment success." <i>PLoS One</i> (2015) http://hdl.handle.net/11427/16154en_ZA
dc.identifier.citationDaniels, J. F., Khogali, M., Mohr, E., Cox, V., Moyo, S., Edginton, M., ... & van Cutsem, G. (2015). Time to ART initiation among patients treated for rifampicin-resistant tuberculosis in Khayelitsha, South Africa: impact on mortality and treatment success. PloS one, 10(11), e0142873. doi:10.1371/journal.pone.0142873en_ZA
dc.identifier.ris TY - Journal Article AU - Daniels, Johnny Flippie AU - Khogali, Mohammed AU - Mohr, Erika AU - Cox, Vivian AU - Moyo, Sizulu AU - Edginton, Mary AU - Hinderaker, Sven Gudmund AU - Meintjes, Graeme AU - Hughes, Jennifer AU - De Azevedo, Virginia AU - van Cutsem, Gilles AU - Cox, Helen Suzanne AB - Setting Khayelitsha, South Africa, with high burdens of rifampicin-resistant tuberculosis (RR-TB) and HIV co-infection. Objective To describe time to antiretroviral treatment (ART) initiation among HIV-infected RR-TB patients initiating RR-TB treatment and to assess the association between time to ART initiation and treatment outcomes. Design A retrospective cohort study of patients with RR-TB and HIV co-infection not on ART at RR-TB treatment initiation. RESULTS: Of the 696 RR-TB and HIV-infected patients initiated on RR-TB treatment between 2009 and 2013, 303 (44%) were not on ART when RR-TB treatment was initiated. The median CD4 cell count was 126 cells/mm 3 . Overall 257 (85%) patients started ART during RR-TB treatment, 33 (11%) within 2 weeks, 152 (50%) between 2-8 weeks and 72 (24%) after 8 weeks. Of the 46 (15%) who never started ART, 10 (21%) died or stopped RR-TB treatment within 4 weeks and 16 (37%) had at least 4 months of RR-TB treatment. Treatment success and mortality during treatment did not vary by time to ART initiation: treatment success was 41%, 43%, and 50% among patients who started ART within 2 weeks, between 2-8 weeks, and after 8 weeks (p = 0.62), while mortality was 21%, 13% and 15% respectively (p = 0.57). Mortality was associated with never receiving ART (adjusted hazard ratio (aHR) 6.0, CI 2.1-18.1), CD4 count ≤100 (aHR 2.1, CI 1.0-4.5), and multidrug-resistant tuberculosis (MDR-TB) with second-line resistance (aHR 2.5, CI 1.1-5.4). CONCLUSIONS: Despite wide variation in time to ART initiation among RR-TB patients, no differences in mortality or treatment success were observed. However, a significant proportion of patients did not initiate ART despite receiving >4 months of RR-TB treatment. Programmatic priorities should focus on ensuring all patients with RR-TB/HIV co-infection initiate ART regardless of CD4 count, with special attention for patients with CD4 counts ≤ 100 to initiate ART as soon as possible after RR-TB treatment initiation. DA - 2015 DB - OpenUCT DO - 10.1371/journal.pone.0142873 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Time to ART initiation among patients treated for rifampicin-resistant tuberculosis in Khayelitsha, South Africa: impact on mortality and treatment success TI - Time to ART initiation among patients treated for rifampicin-resistant tuberculosis in Khayelitsha, South Africa: impact on mortality and treatment success UR - http://hdl.handle.net/11427/16154 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16154
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0142873
dc.identifier.vancouvercitationDaniels JF, Khogali M, Mohr E, Cox V, Moyo S, Edginton M, et al. Time to ART initiation among patients treated for rifampicin-resistant tuberculosis in Khayelitsha, South Africa: impact on mortality and treatment success. PLoS One. 2015; http://hdl.handle.net/11427/16154.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2015 Daniels et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherDrug therapyen_ZA
dc.subject.otherExtensively drug-resistant tuberculosisen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherMulti-drug-resistant tuberculosisen_ZA
dc.subject.otherTreatment guidelinesen_ZA
dc.subject.otherTuberculosis diagnosis and managementen_ZA
dc.titleTime to ART initiation among patients treated for rifampicin-resistant tuberculosis in Khayelitsha, South Africa: impact on mortality and treatment successen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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