Timing, rates, and causes of death in a large South African tuberculosis programme.
Timing, rates, and causes of death in a large South African tuberculosis programme.
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DOI：
10.1186/s12879-014-0679-9
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发表时间：
2014-12-21
影响因子：
3.7
通讯作者：
Sonnenberg P
中科院分区：
文献类型：
--
作者：
Field N;Lim MS;Murray J;Dowdeswell RJ;Glynn JR;Sonnenberg P
尽管纳入了结核病和艾滋病毒/抗逆转录病毒治疗方案，但整个撒哈拉以南非洲的结核病死亡率仍然居高不下。为了向规划设计和服务提供提供信息，我们估计了自开始结核病治疗以来的死亡率。常规收集的关于结核病治疗、生命状况以及死亡时间和原因的数据与1995年至2008年南非一群铂金男性矿工的心肺尸检数据有关。记录被扩展到风险人月(PM)。登记了4162例结核病病例；3170名男子首次接受治疗，833名男子再次接受治疗。总体而言，509名男性死亡，病死率为12.2%，死亡率为2.0/10万。在开始结核病治疗后的第一个月死亡率最高(2.3/100ppm)和再次治疗(4.8/100ppm)。当按HIV状态分层时，未接受抗逆转录病毒疗法(首次发病14.0%；再次接受抗逆转录病毒疗法26.2%)和服用抗逆转录病毒疗法(12.0%；22.0%)的艾滋病毒阳性男性的病死率高于艾滋病毒阴性或未知状态的男性(2.6%；3.6%)。这些人群在第一个月的死亡率也是最高的。死亡危险因素包括高龄、既往结核病、艾滋病毒、肺结核和诊断不确定性。与心肺解剖相比，临床记录中可归因于结核病的死亡比例一直被高估。在所有人群中，艾滋病毒携带者和结核病治疗的第一个月的方案死亡率最高，许多死亡不是由结核病造成的。资源分配应将结核病预防和准确的早期诊断放在首位，认识到艾滋病毒的作用，并确保在结核病治疗的早期阶段提供有效的临床护理。本文的在线版本(doi：10.1186/s12879-0140679-9)包含补充材料，授权用户可以使用。
Tuberculosis (TB) mortality remains high across sub-Saharan Africa despite integration of TB and HIV/ART programmes. To inform programme design and service delivery, we estimated mortality by time from starting TB treatment. Routinely collected data on TB treatment, vital status, and the timing and causes of death, were linked to cardio-respiratory autopsy data, from 1995–2008, from a cohort of male platinum miners in South Africa. Records were expanded into person-months at risk (pm). 4162 TB episodes were registered; 3170 men were treated for the first time and 833 men underwent retreatment. Overall, 509 men died, with a case fatality of 12.2% and mortality rate of 2.0/100 pm. Mortality was highest in the first month after starting TB treatment for first (2.3/100 pm) and retreatment episodes (4.8/100 pm). When stratified by HIV status, case fatality was higher in HIV positive men not on ART (first episode 14.0%; retreatment episode 26.2%) and those on ART (12.0%; 22.0%) than men of negative or unknown HIV status (2.6%; 3.6%). Mortality was also highest in the first month for each of these groups. Mortality risk factors included older age, previous TB, HIV, pulmonary TB, and diagnostic uncertainty. The proportion of deaths attributable to TB was consistently overestimated in clinical records versus cardio-respiratory autopsy. Programme mortality was highest in those with HIV and during the first month of TB treatment in all groups, and many deaths were not caused by TB. Resource allocation should prioritise TB prevention and accurate earlier diagnosis, recognise the role of HIV, and ensure effective clinical care in the early stages of TB treatment. The online version of this article (doi:10.1186/s12879-014-0679-9) contains supplementary material, which is available to authorized users.
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影响因子：
3.8
作者：
Martinson, Neil A.;Karstaedt, Alan;Hale, Martin
通讯作者：
Hale, Martin
DOI：
10.1097/qai.0b013e3181eb611a
发表时间：
2010-12
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Kyeyune R;den Boon S;Cattamanchi A;Davis JL;Worodria W;Yoo SD;Huang L
通讯作者：
Huang L
DOI：
10.1056/nejmoa0905848
发表时间：
2010-02-25
期刊：
The New England journal of medicine
影响因子：
--
作者：
Abdool Karim SS;Naidoo K;Grobler A;Padayatchi N;Baxter C;Gray A;Gengiah T;Nair G;Bamber S;Singh A;Khan M;Pienaar J;El-Sadr W;Friedland G;Abdool Karim Q
通讯作者：
Abdool Karim Q
影响因子：
11.8
作者：
Cain, Kevin P.;Anekthananon, Thanomsak;Varma, Jay K.
通讯作者：
Varma, Jay K.
影响因子：
4.5
作者：
Field N;Murray J;Wong ML;Dowdeswell R;Dudumayo N;Rametsi L;Martinson N;Lipman M;Glynn JR;Sonnenberg P
通讯作者：
Sonnenberg P