Abstract
SettingKenya, 2012–2015ObjectiveTo explore whether there is a gender difference in all-cause mortality among smear positive pulmonary tuberculosis (PTB)/ HIV co-infected patients treated for tuberculosis (TB) between 2012 and 2015 in Kenya.DesignRetrospective cohort of 9,026 smear-positive patients aged 15–49 years. All-cause mortality during TB treatment was the outcome of interest. Time to start of antiretroviral therapy (ART) initiation was considered as a proxy for CD4 cell count. Those who took long to start of ART were assumed to have high CD4 cell count.ResultsOf the 9,026 observations analysed, 4,567(51%) and 4,459(49%) were women and men, respectively. Overall, out of the 9,026 patients, 8,154 (90%) had their treatment outcome as cured, the mean age in years (SD) was 33.3(7.5) and the mean body mass index (SD) was 18.2(3.4). Men were older (30% men’ vs 17% women in those ≥40 years, p = <0.001) and had a lower BMI <18.5 (55.3% men vs 50.6% women, p = <0.001). Men tested later for HIV: 29% (1,317/4,567) of women HIV tested more than 3 months prior to TB treatment, as compared to 20% (912/4,459) men (p<0.001). Mortality was higher in men 11% (471/4,459) compared to women 9% (401/4,567, p = 0.004). There was a 17% reduction in the risk of death among women (adjusted HR 0.83; 95% CI 0.72–0.96; p = 0.013). Survival varied by age-groups, with women having significantly better survival than men, in the age-groups 40 years and over (log-rank p = 0.006).ConclusionWomen with sputum positive PTB/HIV co-infection have a significantly lower risk of all-cause mortality during TB treatment compared to men. Men were older, had lower BMI and tested later for HIV than women.
Highlights
Gender disaggregation of data in tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection is important, for patients in reproductive age (15–49 years) for equity and equality in program service delivery [1]
Men tested later for HIV: 29% (1,317/4,567) of women HIV tested more than 3 months prior to TB treatment, as compared to 20% (912/4,459) men (p
There was a 17% reduction in the risk of death among women
Summary
Gender disaggregation of data in tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection is important, for patients in reproductive age (15–49 years) for equity and equality in program service delivery [1]. In TB/HIV co-infected patients, survival depends on timely initiation of both anti-TB and antiretroviral therapy (ART) treatment [2]. A sub-analysis of a recent study in Kenya that included patients with pulmonary TB (PTB) regardless of their HIV status [6] concluded that women of reproductive age had a worse outcome of PTB treatment compared to age-matched men, attributed to HIV infected patients who were not on ART while on TB treatment. Studies have demonstrated a clear mortality reduction and improved outcome when ART was initiated, regardless of CD4 cell count in all TB/HIV infected patients during TB treatment [2]. Previous work has shown the incidence of TB IRIS in TB/HIV co-infected patients to be 8–43% of TB cases [4, 10]. The risk factors for IRIS are low CD4 cell counts, reduced CD4/CD8 ratio, low haemoglobin level, low body mass index (BMI) and disseminated TB disease [4]
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