Delayed HIV treatment, barriers in access to care and mortality in tuberculosis/HIV co-infected patients in Cali, Colombia
Main Article Content
To determine factors associated with mortality in tuberculosis/HIV co-infected patients in Cali, Colombia
This retrospective cohort design included tuberculosis/HIV co-infected persons. Kaplan-Meier and Cox regression were used to estimate survival and risk factors associated with mortality.
Of the 279 tuberculosis/HIV co-infected participants, 27.2% died during the study. Participants mainly were adults and males. CD4 count information was available for 41.6% (the median count was 83 cells/mm3), and half were subject to tuberculosis susceptibility testing. The median time between HIV diagnosis and antiretroviral therapy initiation was 372 days. HIV was identified prior to tuberculosis in 53% and concurrent HIV-tuberculosis were diagnosed in 37% of patients. 44.8% had tuberculosis treatment success. Body mass index above 18 kg/m2, initiation of tuberculosis treatment within two weeks, having any health insurance coverage and CD4 count information conferred a survival advantage.
Delays in treatment initiation and factors associated with limited health care access or utilization were associated with mortality. As HIV and tuberculosis are both reportable conditions in Colombia, strategies should be focused on optimizing treatment outcomes within both tuberculosis and HIV programs, particularly improving early HIV diagnosis, early antiretroviral therapy treatment initiation, and adherence to tuberculosis treatment.
UNAIDS. Global HIV & AIDS statistics - Fact sheet. UNAIDS; 2021. Cited: 2021 Nov 24. Available from: https://www.unaids.org/en/resources/fact-sheet
World Health Organization. Global tuberculosis report 2021. WHO; 2021. Cited: 2021 Nov 29. Available from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports
Maponga BA, Chirundu D, Gombe NT, Tshimanga M, Bangure D, Takundwa L. Delayed initiation of antiretroviral therapy in TB/HIV co-infected patients, Sanyati District, Zimbabwe, 2011-2012. Pan Afr Med J. 2015; 21:1-6 https://doi.org/10.11604/pamj.2015.21.28.5195 PMid:26401222 PMCid:PMC4561155
Manosuthi W, Wiboonchutikul S, Sungkanuparph S. Integrated therapy for HIV and tuberculosis. AIDS Res Ther. 2016;13:22: https://doi.org/10.1186/s12981-016-0106-y PMid:27182275 PMCid:PMC4866405
Gesesew H, Tsehayneh B, Massa D, Gebremedhin A, Kahsay H, Mwanri L. Predictors of mortality in a cohort of tuberculosis/HIV co-infected patients in Southwest Ethiopia. Infect Dis Poverty. 2016; 5:1-9: https://doi.org/10.1186/s40249-016-0202-1 PMid:27915999 PMCid:PMC5137204
Podlekareva DN, Efsen AMW, Schultze A, Post FA, Skrahina AM, Panteleev A, et al. Tuberculosis-related mortality in people living with HIV in Europe and Latin America: an international cohort study. Lancet HIV. 2016; 3(3): e120-31: https://doi.org/10.1016/S2352-3018(15)00252-0
Instituto Nacional de Salud. Vigilancia centinela de VIH en personas con tuberculosis en Barranquilla, Bucaramanga, Medellín y Cali, 2009 - 2010. 1. ed. Bogotá: Instituto Nacional de Salud; 2011. 56 p.
Ministerio de Salud y Protección Social. Evaluación de la implementación de los planes nacionales de respuesta ante ITS-VIH/SIDA, acciones colaborativas TB-VIH, hepatitis virales, 2014-2017. Ministerio de Salud y Protección Social; 2018. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/ET/evaluacion-implementacion-planes-nal-vih.pdf
Lesmes M, Reina L. Informe anual 2017. Vigilancia en salud pública. Gobernación Valle del Cauca. 2017. Available from: https://www.valledelcauca.gov.co/loader.php?lServicio=Tools2&lTipo=viewpdf&id=545file:///C:/Users/USUARIO/Downloads/Boletin%20epidemiologico%202016-%20dic15-2017%20(1).pdf
WHO. WHO Tuberculosis Treatment Outcomes. Data provided by countries for the Global Tuberculosis Report. WHO; 2017. Available from: http://www.who.int/tb/country/data/download/en/
Gómez LM, Paniagua-Saldarriaga LA, Richert Q, Keynan Y, Montes F, López L, et al. Homelessness and HIV: A combination predictive of poor tuberculosis treatment outcomes and in need of innovative strategies to improve treatment completion. Am J Trop Med Hyg. 2019; 100(4): 932-9: https://doi.org/10.4269/ajtmh.18-0305 PMid:30860023 PMCid:PMC6447114
OMS. Política de la OMS sobre actividades de colaboración TB/VIH. Guía para programas nacionales y otros interesados directos. WHO; 2012. Cited: 2019 Oct 8. Available from: https://apps.who.int/iris/bitstream/handle/10665/44838/9789243503004_spa.pdf;jsessionid=0F11C9E38EDDEFB3796401155ACA1CF9?sequence=1
World Health Organization. WHO Definitions and reporting framework for tuberculosis. WHO; 2013. Cited 2018 Mar 19. Available from: https://apps.who.int/iris/handle/10665/79199
OIM, Instituto Nacional de Salud, Ministerio de Salud y Protección Social. Plan de Monitoreo y Evaluación. Programa Nacional de Prevención y Control de la Tuberculosis. Ministerio de Salud y Protección Social; 2017. Cited 2019 Oct 6. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/ET/plan-monitoreo-evaluacion-tuberculosis.pdf
WHO. WHO Verbal autopsy standards: ascertaining and attributing causes of death [Internet]. WHO; 2016. Cited 2019 Oct 6. Available from: http://www.who.int/healthinfo/statistics/verbalautopsystandards/en/
WHO. Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy. WHO; 2017. Cited 2017 Dec 26. Available from: http://www.who.int/hiv/pub/guidelines/advanced-HIV-disease/en/
INSIGHT START Study Group, Lundgren JD, Babiker AG, Gordin F, Emery S, Grund B, et al. Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. N Engl J Med. 2015; 373(9): 795-807: https://doi.org/10.1056/NEJMoa1506816 PMid:26192873 PMCid:PMC4569751
World Health Organization. Guidelines for intensifid tuberculosis case- finding and isoniazid preventive therapy for people living with HIV in resource- constrained settings. WHO; 2011. Cited 2017 Dec 21]. Available from: http://apps.who.int/iris/bitstream/10665/44472/1/9789241500708_eng.pdf.
Golub J, Saraceni V, Cavalcante S, Pacheco A, Moulton L, King B, et al. The impact of antiretroviral therapy and isoniazid preventive therapy on tuberculosis incidence in HIV-infected patients in Rio de Janeiro, Brazil. AIDS. 2007; 21(11) :1441-8: https://doi.org/10.1097/QAD.0b013e328216f441 PMid:17589190 PMCid:PMC3063947
WHO. WHO The End TB Strategy. WHO; 2021. Cited 2021 Oct 27. Available from: http://www.who.int/tb/strategy/en/
Oxlade O, Schwartzman K, Behr MA, Benedetti A, Pai M, Heymann J, et al. Global tuberculosis trends: a reflection of changes in tuberculosis control or in population health?. Int J Tuberc Lung Dis. 200913(10):1238-46
Raviglione M, Sulis G. Tuberculosis 2015: burden, challenges and strategy for control and elimination. Infect Dis Rep. 2016; 8(2): 33-37. https://doi.org/10.4081/idr.2016.6570 PMid:27403269 PMCid:PMC4927938
Umeh C, Feeley F. Inequitable access to health care by the poor in community-based health insurance programs: a review of studies from low- and middle-income countries. Glob Health Sci Pr. 2017; 5(2): 299-314: https://doi.org/10.9745/GHSP-D-16-00286 PMid:28655804 PMCid:PMC5487091
Nguyen KH, Sommers BD. Access and quality of care by insurance type for low-income adults before the affordable care act. Am J Public Health. 2016; 106(8): 1409-15: https://doi.org/10.2105/AJPH.2016.303156 PMid:27196646 PMCid:PMC4940636
Srivastava D, McGuire A. Patient access to health care and medicines across low-income countries. Soc Sci Med. 2015; 133: 21-7: https://doi.org/10.1016/j.socscimed.2015.03.021 PMid:25829195
Benzekri NA, Sambou JF, Tamba IT, Diatta JP, Sall I, Cisse O, et al. Nutrition support for HIV-TB co-infected adults in Senegal, West Africa: A randomized pilot implementation study. PloS One. 2019; 14(7): e0219118: https://doi.org/10.1371/journal.pone.0219118 PMid:31318879 PMCid:PMC6638996
Zachariah R, Spielmann MP, Harries AD, Salaniponi FML. Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early death. Trans R Soc Trop Med Hyg. 2002; 96(3): 291-4: https://doi.org/10.1016/S0035-9203(02)90103-3
Essomba NE, Ngaba PG, Halle MP, Afane-Voundi Y, Coppieters Y. Risk factors for mortality in patients with tuberculosis and HIV in Douala (Cameroon). Med Sante Trop. 2017; 27(3): 286-91: https://doi.org/10.1684/mst.2017.0713 PMid:28947405
Varma JK, Nateniyom S, Akksilp S, Mankatittham W, Sirinak C, Sattayawuthipong W, et al. HIV care and treatment factors associated with improved survival during TB treatment in Thailand: an observational study. BMC Infect Dis. 2009; 9(1): 42: https://doi.org/10.1186/1471-2334-9-42 PMid:19364398 PMCid:PMC2674442
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The copy rights of the articles published in Colombia Médica belong to the Universidad del Valle. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Colombia Médica without prior authorization for non-commercial use