title: Treatment outcomes of new tuberculosis patients hospitalized in Kampala, Uganda: a prospective cohort study.
abstract: BACKGROUND
  In most resource limited settings, new tuberculosis (TB) patients are usually treated as outpatients. We sought to investigate the reasons for hospitalisation and the predictors of poor treatment outcomes and mortality in a cohort of hospitalized new TB patients in Kampala, Uganda.
  
  
  RESULTS
  Ninety-six new TB patients hospitalised between 2003 and 2006 were enrolled and followed for two years. Thirty two were HIV-uninfected and 64 were HIV-infected. Among the HIV-uninfected, the commonest reasons for hospitalization were low Karnofsky score (47%) and need for diagnostic evaluation (25%). HIV-infected patients were commonly hospitalized due to low Karnofsky score (72%), concurrent illness (16%) and diagnostic evaluation (14%). Eleven HIV uninfected patients died (mortality rate 19.7 per 100 person-years) while 41 deaths occurred among the HIV-infected patients (mortality rate 46.9 per 100 person years). In all patients an unsuccessful treatment outcome (treatment failure, death during the treatment period or an unknown outcome) was associated with duration of TB symptoms, with the odds of an unsuccessful outcome decreasing with increasing duration. Among HIV-infected patients, an unsuccessful treatment outcome was also associated with male sex (P = 0.004) and age (P = 0.034). Low Karnofsky score (aHR = 8.93, 95% CI 1.88 - 42.40, P = 0.001) was the only factor significantly associated with mortality among the HIV-uninfected. Mortality among the HIV-infected was associated with the composite variable of CD4 and ART use, with patients with baseline CD4 below 200 cells/µL who were not on ART at a greater risk of death than those who were on ART, and low Karnofsky score (aHR = 2.02, 95% CI 1.02 - 4.01, P = 0.045).
  
  
  CONCLUSIONS
  Poor health status is a common cause of hospitalisation for new TB patients. Mortality in this study was very high and associated with advanced HIV Disease and no use of ART.
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Kirenga
authors.affiliation: Medical Research Council-Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda; School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Levin
authors.affiliation: Makerere University - Boston Medical Center Research Collaboration, Kampala, Uganda.
authors.forename: Irene
authors.initials: I
authors.lastname: Ayakaka
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: William
authors.initials: W
authors.lastname: Worodria
authors.affiliation: Department of Medicine, New Jersey Medical School - Rutgers University, Newark, New Jersey, United States of America.
authors.forename: Nancy
authors.initials: N
authors.lastname: Reilly
authors.affiliation: Department of Microbiology, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Francis
authors.initials: F
authors.lastname: Mumbowa
authors.affiliation: Makerere University - Boston Medical Center Research Collaboration, Kampala, Uganda.
authors.forename: Helen
authors.initials: H
authors.lastname: Nabanjja
authors.affiliation: Makerere University - Boston Medical Center Research Collaboration, Kampala, Uganda.
authors.forename: Grace
authors.initials: G
authors.lastname: Nyakoojo
authors.affiliation: Southeastern National Tuberculosis Center, Division of Mycobacteriology, Department of Medicine, University of Florida, Gainesville, Florida, United States of America; Makerere University - Boston Medical Center Research Collaboration, Kampala, Uganda.
authors.forename: Kevin
authors.initials: K
authors.lastname: Fennelly
authors.affiliation: Medical Research Council-Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: Susan
authors.initials: S
authors.lastname: Nakubulwa
authors.affiliation: Department of Microbiology, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Moses
authors.initials: M
authors.lastname: Joloba
authors.affiliation: Medical Research Council-Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda; Mulago Hospital Tuberculosis Clinic, Mulago Hospital, Kampala, Uganda.
authors.forename: Alphonse
authors.initials: A
authors.lastname: Okwera
authors.affiliation: Departments of Pathology and, Microbiology and Immunology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America.
authors.forename: Kathleen D
authors.initials: KD
authors.lastname: Eisenach
authors.affiliation: Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, England.
authors.forename: Ruth
authors.initials: R
authors.lastname: McNerney
authors.affiliation: Medical Research Council-Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe, Uganda; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, England.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Elliott
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Makerere University - Boston Medical Center Research Collaboration, Kampala, Uganda.
authors.forename: Roy D
authors.initials: RD
authors.lastname: Mugerwa
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Smith
authors.affiliation: Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, United States of America; Makerere University - Boston Medical Center Research Collaboration, Kampala, Uganda.
authors.forename: Jerrold J
authors.initials: JJ
authors.lastname: Ellner
authors.affiliation: Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, United States of America; Makerere University - Boston Medical Center Research Collaboration, Kampala, Uganda.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Jones-López
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000401:mortality*; D014454:Uganda; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents