title: High mortality in tuberculosis patients despite HIV interventions in Swaziland.
abstract: METHODS
  All health facilities providing tuberculosis (TB) care in Swaziland.
  
  
  OBJECTIVE
  To describe the impact of human immunodeficiency virus (HIV) interventions on the trend of TB treatment outcomes during 2010-2013 in Swaziland; and to describe the evolution in TB case notification, the uptake of HIV testing, antiretroviral therapy (ART) and cotrimoxazole preventive therapy (CPT), and the proportion of TB-HIV co-infected patients with adverse treatment outcomes, including mortality, loss to follow-up and treatment failure.
  
  
  METHODS
  A retrospective descriptive study using aggregated national TB programme data.
  
  
  RESULTS
  Between 2010 and 2013, TB case notifications in Swaziland decreased by 40%, HIV testing increased from 86% to 96%, CPT uptake increased from 93% to 99% and ART uptake among TB patients increased from 35% to 75%. The TB-HIV co-infection rate remained around 70% and the proportion of TB-HIV cases with adverse outcomes decreased from 36% to 30%. Mortality remained high, at 14-16%, over the study period, and anti-tuberculosis treatment failure rates were stable over time (<5%).
  
  
  CONCLUSIONS
  Despite high CPT and ART uptake in TB-HIV patients, mortality remained high. Further studies are required to better define high-risk patient groups, understand the reasons for death and design appropriate interventions.
authors.affiliation: National TB Control Programme, Ministry of Health, Manzini, Swaziland.
authors.forename: G
authors.initials: G
authors.lastname: Mchunu
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: van Griensven
authors.affiliation: University of Bergen, Bergen, Norway.
authors.forename: S G
authors.initials: SG
authors.lastname: Hinderaker
authors.affiliation: Médecins Sans Frontières (MSF), Operational Centre Brussels, Kenya Mission, Nairobi, Kenya.
authors.forename: W
authors.initials: W
authors.lastname: Kizito
authors.affiliation: National TB Control Programme, Ministry of Health, Manzini, Swaziland.
authors.forename: W
authors.initials: W
authors.lastname: Sikhondze
authors.affiliation: MSF, Medical Department, Operational Research Unit, Luxembourg.
authors.forename: M
authors.initials: M
authors.lastname: Manzi
authors.affiliation: National TB Control Programme, Ministry of Health, Manzini, Swaziland.
authors.forename: T
authors.initials: T
authors.lastname: Dlamini
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
keywords: Swaziland; antiretroviral treatment; mortality; operational research; tuberculosis