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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{"title"=>"Time to ART initiation among patients treated for rifampicin-resistant tuberculosis in khayelitsha, South Africa: Impact on mortality and treatment success", "type"=>"journal", "authors"=>[{"first_name"=>"Johnny Flippie", "last_name"=>"Daniels", "scopus_author_id"=>"56573433200"}, {"first_name"=>"Mohammed", "last_name"=>"Khogali", "scopus_author_id"=>"37102005900"}, {"first_name"=>"Erika", "last_name"=>"Mohr", "scopus_author_id"=>"56754796400"}, {"first_name"=>"Vivian", "last_name"=>"Cox", "scopus_author_id"=>"55948194500"}, {"first_name"=>"Sizulu", "last_name"=>"Moyo", "scopus_author_id"=>"15840110800"}, {"first_name"=>"Mary", "last_name"=>"Edginton", "scopus_author_id"=>"16425625900"}, {"first_name"=>"Sven Gudmund", "last_name"=>"Hinderaker", "scopus_author_id"=>"6603049904"}, {"first_name"=>"Graeme", "last_name"=>"Meintjes", "scopus_author_id"=>"13612258700"}, {"first_name"=>"Jennifer", "last_name"=>"Hughes", "scopus_author_id"=>"56345639600"}, {"first_name"=>"Virginia", "last_name"=>"De Azevedo", "scopus_author_id"=>"35776048600"}, {"first_name"=>"Gilles", "last_name"=>"Van Cutsem", "scopus_author_id"=>"24768129500"}, {"first_name"=>"Helen Suzanne", "last_name"=>"Cox", "scopus_author_id"=>"35228720000"}], "year"=>2015, "source"=>"PLoS ONE", "identifiers"=>{"doi"=>"10.1371/journal.pone.0142873", "sgr"=>"84953265639", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)", "pmid"=>"26555134", "issn"=>"19326203", "scopus"=>"2-s2.0-84953265639", "pui"=>"607497186"}, "id"=>"3892c037-3350-3aae-b204-74e94ce78731", "abstract"=>"SETTING: Khayelitsha, South Africa, with high burdens of rifampicin-resistant tuberculosis (RR-TB) and HIV co-infection.\\n\\nOBJECTIVE: 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.\\n\\nDESIGN: A retrospective cohort study of patients with RR-TB and HIV co-infection not on ART at RR-TB treatment initiation.\\n\\nRESULTS: 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/mm3. 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).\\n\\nCONCLUSIONS: 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.", "link"=>"http://www.mendeley.com/research/time-art-initiation-among-patients-treated-rifampicinresistant-tuberculosis-khayelitsha-south-africa", "reader_count"=>42, "reader_count_by_academic_status"=>{"Unspecified"=>3, "Professor > Associate Professor"=>2, "Researcher"=>11, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>2, "Student > Postgraduate"=>4, "Student > Master"=>8, "Other"=>5, "Student > Bachelor"=>2, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>1, "Professor"=>2}, "reader_count_by_user_role"=>{"Unspecified"=>3, "Professor > Associate Professor"=>2, "Researcher"=>11, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>2, "Student > Postgraduate"=>4, "Student > Master"=>8, "Other"=>5, "Student > Bachelor"=>2, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>1, "Professor"=>2}, "reader_count_by_subject_area"=>{"Unspecified"=>4, "Nursing and Health Professions"=>3, "Biochemistry, Genetics and Molecular Biology"=>1, "Mathematics"=>1, "Medicine and Dentistry"=>30, "Psychology"=>1, "Social Sciences"=>2}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>30}, "Social Sciences"=>{"Social Sciences"=>2}, "Psychology"=>{"Psychology"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>3}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>4}}, "reader_count_by_country"=>{"United States"=>1, "United Kingdom"=>1}, "group_count"=>3}

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Relative Metric

{"start_date"=>"2015-01-01T00:00:00Z", "end_date"=>"2015-12-31T00:00:00Z", "subject_areas"=>[]}
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