title: Outcomes of TB treatment by HIV status in national recording systems in Brazil, 2003-2008.
abstract: BACKGROUND
  Although the Brazilian national reporting system for tuberculosis cases (SINAN) has enormous potential to generate data for policy makers, formal assessments of treatment outcomes and other aspects of TB morbidity and mortality are not produced with enough depth and rigor. In particular, the effect of HIV status on these outcomes has not been fully explored, partly due to incomplete recording in the national database.
  
  
  RESULTS
  In a retrospective cohort study, we assessed TB treatment outcomes, including rates of cure, default, mortality, transfer and multidrug resistant TB (MDR-TB) among a purposively chosen sample of 161,481 new cases reported in SINAN between 2003 and 2008. The study population included all new cases reported in the six States with the highest level of completeness of the HIV status field in the system. These cases were mostly male (67%), white (62%), had pulmonary TB (79%) and a suspect chest X ray (83%). Treatment outcomes were best for those HIV negative cases and worst for those known HIV positive patients (cure rate of 85.7% and 55.7% respectively). In multivariate modeling, the risk of having an unfavorable outcome (all outcomes except cure) was 3.09 times higher for those HIV positive compared with those HIV negative (95% CI 3.02-3.16). The risk of death and default also increased with HIV positivity. The group without a known HIV status showed intermediate outcomes between the groups above, suggesting that this group includes some with HIV infection.
  
  
  CONCLUSIONS
  HIV status played an important role in TB treatment outcomes in the study period. The outcomes observed in those with known HIV were poor and need to be improved. Those in the group with unknown HIV status indicate the need for wider HIV testing among new TB cases.
authors.affiliation: Department of Public Health, University of Brasilia, Brasilia, Brazil. mauro.sanchez4@gmail.com
authors.forename: Mauro
authors.initials: M
authors.lastname: Sanchez
authors.forename: Patricia
authors.initials: P
authors.lastname: Bartholomay
authors.forename: Denise
authors.initials: D
authors.lastname: Arakaki-Sanchez
authors.forename: Donald
authors.initials: D
authors.lastname: Enarson
authors.forename: Karen
authors.initials: K
authors.lastname: Bissell
authors.forename: Draurio
authors.initials: D
authors.lastname: Barreira
authors.forename: Anthony
authors.initials: A
authors.lastname: Harries
authors.forename: Afrânio
authors.initials: A
authors.lastname: Kritski
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000453:epidemiology; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D004282:Documentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents