title: Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients.
abstract: OBJECTIVE
  To assess health care utilisation for patients co-infected with TB and HIV (TB-HIV), and to develop a weighted health care index (HCI) score based on commonly used interventions and compare it with patient outcome.
  
  
  METHODS
  A total of 1061 HIV patients diagnosed with  TB in four regions, Central/Northern, Southern and Eastern Europe and Argentina, between January 2004 and December 2006 were enrolled in the TB-HIV study. A weighted HCI score (range 0-5), based on independent prognostic factors identified in multivariable Cox models and the final score,  included performance of TB drug susceptibility testing (DST), an initial TB regimen containing a rifamycin, isoniazid and pyrazinamide, and start of combination antiretroviral treatment (cART).
  
  
  RESULTS
  The mean HCI score was highest in Central/Northern Europe (3.2, 95%CI 3.1-3.3)  and lowest in Eastern Europe (1.6, 95%CI 1.5-1.7). The cumulative probability of death 1 year after TB diagnosis decreased from 39% (95%CI 31-48) among patients with an HCI score of 0, to 9% (95%CI 6-13) among those with a score of ≥4. In an adjusted Cox model, a 1-unit  increase in the HCI score was associated with 27% reduced mortality (relative hazard 0.73, 95%CI 0.64-0.84).
  
  
  CONCLUSIONS
  Our results suggest that DST, standard anti-tuberculosis treatment and early cART may improve outcome for TB-HIV patients. The proposed HCI score provides a tool  for future research and monitoring of the management of TB-HIV patients. The highest HCI score may serve as a benchmark to assess TB-HIV management, encouraging continuous health care improvement.
authors: Copenhagen HIV Programme, University of Copenhagen, Denmark. dpo@cphiv.dk
authors: D N
authors: DN
authors: Podlekareva
authors: D
authors: D
authors: Grint
authors: F A
authors: FA
authors: Post
authors: A
authors: A
authors: Mocroft
authors: A M
authors: AM
authors: Panteleev
authors: R F
authors: RF
authors: Miller
authors: J M
authors: JM
authors: Miro
authors: M
authors: M
authors: Bruyand
authors: H
authors: H
authors: Furrer
authors: V
authors: V
authors: Riekstina
authors: E
authors: E
authors: Girardi
authors: M H
authors: MH
authors: Losso
authors: J A
authors: JA
authors: Caylá
authors: E A
authors: EA
authors: Malashenkov
authors: N
authors: N
authors: Obel
authors: A M
authors: AM
authors: Skrahina
authors: J D
authors: JD
authors: Lundgren
authors: O
authors: O
authors: Kirk
mesh_terms: D017088:AIDS-Related Opportunistic Infections; D000328:Adult; D002423:Cause of Death / Q000639:trends; D060085:Coinfection / Q000175:diagnosis / Q000401:mortality*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006679:HIV Seropositivity / Q000150:complications / Q000401:mortality*; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D014376:Tuberculosis / Q000175:diagnosis* / Q000401:mortality