Unfavourable TB Outcomes in PLHIV with Delayed TB Treatment Initiation—A Retrospective Analysis

Abstract

Background & Objectives: Timely initiation of anti-tubercular treatment (ATT) is key to obtain favourable outcomes among people living with HIV (PLHIV) co-infected with tuberculosis (TB). There is little evidence to predict treatment outcome and the delay in initiation of ATT among co-infected. The analysis explores the relationship between different ATT initiation delay times and TB outcomes. Methods: Retrospective analysis of secondary data of HIV-TB co-infected patients attending two antiretroviral therapy (ART) clinics in Pune district of Maharashtra, India. Logistic regression models were used to calculate risk. Results: Of the total 457 co-infected PLHIV initiated on ATT from December 2016 to June 2018, there were 298 who had completed TB treatment. Outcomes of ATT were available for 243 patients. Of the 243 patient’s records analysed, 61% were males and ≤11% were less than 18 years. 20% were previously treated. The risk of unfavourable outcomes increased monotonically from OR = 1.1, to OR = 1.73 for >2 days to >7 days delay in ATT initiation respectively. Males (OR = 2.11), newly initiated patients (OR = 1.54) are exposed to higher risk of unfavourable TB outcomes when ATT initiation is delayed beyond seven days. Conclusion: Risk of unfavourable outcomes increase in delay time for ATT initiation. Patient characters should be considered for prioritised referral and availability of test results on the same day of diagnosis to foster same day ATT initiation. More analysis on larger data sets with richer clinical information will generate confirmatory evidence.