title: Factors Associated with Mortality among Patients on TB Treatment in the Southern Region of Zimbabwe, 2013.
abstract: Background. In 2013, the tuberculosis (TB) mortality rate was highest in southern Zimbabwe at 16%. We therefore sought to determine factors associated with mortality among registered TB patients in this region.Methodology. This was a retrospective record review of registered patients receiving anti-TB treatment in 2013.Results. Of 1,971 registered TB patients, 1,653 (84%) were new cases compared with 314 (16%) retreatment cases. There were 1,538 (78%) TB/human immunodeficiency virus (HIV) coinfected patients, of whom 1,399 (91%) were on antiretroviral therapy (ART) with median pre-ART CD4 count of 133 cells/uL (IQR, 46-282). Overall, 428 (22%) TB patients died. Factors associated with increased mortality included being ≥65 years old [adjusted relative risk (ARR) = 2.48 (95% CI 1.35-4.55)], a retreatment TB case [ARR = 1.34 (95% CI, 1.10-1.63)], and being HIV-positive [ARR = 1.87 (95% CI, 1.44-2.42)] whilst ART initiation was protective [ARR = 0.25 (95% CI, 0.22-0.29)]. Cumulative mortality rates were 10%, 14%, and 21% at one, two, and six months, respectively, after starting TB treatment.Conclusion. There was high mortality especially in the first two months of anti-TB treatment, with risk factors being recurrent TB and being HIV-infected, despite a high uptake of ART.
authors.affiliation: AIDS & TB Department, Ministry of Health & Child Care, Harare, Zimbabwe; International Union against Tuberculosis and Lung Disease, Paris, France.
authors.forename: Kudakwashe C
authors.identifier: 0000-0002-2980-7735
authors.initials: KC
authors.lastname: Takarinda
authors.affiliation: AIDS & TB Department, Ministry of Health & Child Care, Harare, Zimbabwe.
authors.forename: Charles
authors.initials: C
authors.lastname: Sandy
authors.affiliation: Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: Nyasha
authors.initials: N
authors.lastname: Masuka
authors.affiliation: World Health Organisation Country Office, Harare, Zimbabwe.
authors.forename: Patrick
authors.initials: P
authors.lastname: Hazangwe
authors.affiliation: AIDS & TB Department, Ministry of Health & Child Care, Harare, Zimbabwe.
authors.forename: Regis C
authors.initials: RC
authors.lastname: Choto
authors.affiliation: AIDS & TB Department, Ministry of Health & Child Care, Harare, Zimbabwe.
authors.forename: Tsitsi
authors.initials: T
authors.lastname: Mutasa-Apollo
authors.affiliation: AIDS & TB Department, Ministry of Health & Child Care, Harare, Zimbabwe.
authors.forename: Brilliant
authors.initials: B
authors.lastname: Nkomo
authors.affiliation: Health Services Department, Bulawayo, Zimbabwe.
authors.forename: Edwin
authors.initials: E
authors.lastname: Sibanda
authors.affiliation: AIDS & TB Department, Ministry of Health & Child Care, Harare, Zimbabwe.
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
authors.affiliation: International Union against Tuberculosis and Lung Disease, Paris, France; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Anthony D
authors.identifier: 0000-0001-6113-9741
authors.initials: AD
authors.lastname: Harries
authors.affiliation: AIDS & TB Department, Ministry of Health & Child Care, Harare, Zimbabwe.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Siziba