title: Mortality among tuberculosis patients in the Democratic Republic of Congo.
abstract: METHODS
  Kinshasa, Democratic Republic of Congo.
  
  
  OBJECTIVE
  To identify programmatic interventions for improved survival in patients receiving treatment for tuberculosis (TB) at primary care clinics.
  
  
  METHODS
  Retrospective cohort of adult patients initiating anti-tuberculosis treatment  between January 2006 and May 2007.
  
  
  RESULTS
  Among 5685 patients, 390 deaths occurred during anti-tuberculosis treatment, of which half (52%) did so during the first 2 months. Patients with smear-negative pulmonary TB were at greater risk of death in the first 2 months of treatment (human  immunodeficiency virus [HIV] positive HR 1.49, 95%CI 0.89-2.49; HIV-negative HR 1.77 95%CI 1.06-2.95), but not thereafter. Patients with extra-pulmonary TB were at increased risk of death in the first 2 months of anti-tuberculosis treatment if they were non-HIV-infected (HR 2.42,  95%CI 1.52-3.85), and were half as likely to die during the remainder of treatment (HIV-positive HR 0.46, 95%CI 0.22-0.97; HIV-negative HR 0.47, 95%CI 0.23-0.94). Antiretroviral therapy (ART) reduced the risk of death by an estimated 36% (HR 0.64, 95%CI 0.37-1.11).
  
  
  CONCLUSIONS
  High mortality in the first months of anti-tuberculosis treatment could be reduced by addressing diagnostic delays, particularly for extra-pulmonary and smear-negative TB cases and, in HIV-infected patients, by initiation of ART soon after starting anti-tuberculosis treatment.
authors.affiliation: Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. cashene@email.unc.edu
authors.forename: C
authors.initials: C
authors.lastname: Henegar
authors.forename: F
authors.initials: F
authors.lastname: Behets
authors.forename: K
authors.initials: K
authors.lastname: Vanden Driessche
authors.forename: M
authors.initials: M
authors.lastname: Tabala
authors.forename: E
authors.initials: E
authors.lastname: Bahati
authors.forename: V
authors.initials: V
authors.lastname: Bola
authors.forename: A
authors.initials: A
authors.lastname: Van Rie
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D060085:Coinfection; D057210:Delayed Diagnosis; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D011237:Predictive Value of Tests; D011320:Primary Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents