scholarly journals Mortality during tuberculosis treatment in South Africa using an 8-year analysis of the national tuberculosis treatment register

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Muhammad Osman ◽  
Cari van Schalkwyk ◽  
Pren Naidoo ◽  
James A. Seddon ◽  
Rory Dunbar ◽  
...  
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Cox Regression ◽  
Case Fatality ◽  
Hiv Treatment ◽  
Tuberculosis Treatment ◽  
Eligibility Criteria ◽  
Tb Treatment ◽  
Treatment Register ◽  
The Impact

AbstractIn 2011, the South African HIV treatment eligibility criteria were expanded to allow all tuberculosis (TB) patients lifelong ART. The impact of this change on TB mortality in South Africa is not known. We evaluated mortality in all adults (≥ 15 years old) treated for drug-susceptible TB in South Africa between 2009 and 2016. Using a Cox regression model, we quantified risk factors for mortality during TB treatment and present standardised mortality ratios (SMR) stratified by year, age, sex, and HIV status. During the study period, 8.6% (219,618/2,551,058) of adults on TB treatment died. Older age, male sex, previous TB treatment and HIV infection (with or without the use of ART) were associated with increased hazard of mortality. There was a 19% reduction in hazard of mortality amongst all TB patients between 2009 and 2016 (adjusted hazard ratio: 0.81 95%CI 0.80–0.83). The highest SMR was in 15–24-year-old women, more than double that of men (42.3 in 2016). Between 2009 and 2016, the SMR for HIV-positive TB patients increased, from 9.0 to 19.6 in women, and 7.0 to 10.6 in men. In South Africa, case fatality during TB treatment is decreasing and further interventions to address specific risk factors for TB mortality are required. Young women (15–24-year-olds) with TB experience a disproportionate burden of mortality and interventions targeting this age-group are needed.

Abstract 88: Social Inequalities in Stroke Mortality, Incidence and Case-fatality in Europe.

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Marco M Ferrario ◽  
Giovanni Veronesi ◽  
Kari Kuulasmaa ◽  
Martin Bobak ◽  
Lloyd E Chambless ◽  
...  
Keyword(s):  
Risk Factors ◽  
Social Inequalities ◽  
Cox Regression ◽  
Case Fatality ◽  
Stroke Mortality ◽  
Stroke Incidence ◽  
Low Education ◽  
Mortality Incidence ◽  
European Populations

Introduction and aim: There are limited comparative data on social inequalities in stroke morbidity across Europe. We aimed to assess the magnitude of educational class inequalities in stroke mortality, incidence and 1-year case-fatality in European populations. Methods: The MORGAM study comprised 45 cohorts from Finland, Denmark, Sweden, Northern Ireland, Scotland, France, Germany, Italy, Lithuania, Poland and Russia, mostly recruited in mid 1980s-early 90s. Baseline data collection and follow-up (median 12 years) for fatal and non-fatal strokes adhered to MONICA-like procedures. Stroke mortality was defined according to the underlying cause of death (ICD-IX codes 430-438 or ICD-X I60-I69). We derived 3 educational classes from population-, sex- and birth year-specific tertiles of years of schooling. We estimated the age-adjusted difference in event rates, and the age- and risk factor-adjusted hazard ratios (HRs), between the bottom and the top of the educational class distribution from sex- and population-specific Poisson and Cox regression models, respectively. The association between 1-year case-fatality and education was estimated through logistic models adjusted for risk factors. Results: Among the 91,563 CVD-free participants aged 35-74 at baseline, 1037 stroke deaths and 3902 incident strokes occurred during follow-up. Low education accounted for 26 additional stroke deaths per 100,000 person-years in men (95%CI: 9 to 42), and 19 (7 to 32) in women. In both genders, inequalities in fatal stroke rates were larger in the East EU and in the Nordic Countries populations. The age-adjusted pooled HRs of first stroke, fatal or non-fatal, for the least educated men and women were 1.52 (95%CI: 1.29-1.78) and 1.51 (1.25-1.81), respectively, consistently across populations. Adjustment for smoking, blood pressure, HDL-cholesterol and diabetes attenuated the pooled HRs to 1.34 (95%CI: 1.14-1.57) in men and 1.29 (1.07-1.55) in women. A significant association between low education and increased 1-year case-fatality was observed in Northern Sweden only. Conclusions: Social inequalities in stroke incidence are widespread in most European populations, and less than half of the gap is explained by major risk factors.

scholarly journals SimpactCyan 1.0: An Open-source Simulator for Individual-Based Models in HIV Epidemiology with R and Python Interfaces

2018 ◽  
Author(s):  
Jori Liesenborgs ◽  
Diana M Hendrickx ◽  
Elise Kuylen ◽  
David Niyukuri ◽  
Niel Hens ◽  
...  
Keyword(s):  
Open Source ◽  
Hiv Infections ◽  
Hiv Treatment ◽  
Model Parameters ◽  
Eligibility Criteria ◽  
Hiv Epidemiology ◽  
Treatment And Prevention ◽  
Individual Based Models ◽  
Prevention Programmes ◽  
The Impact

ABSTRACTSimpactCyan is an open-source simulator for individual-based models in HIV epidemiology. Its core algorithm is written in C++ for computational efficiency, while the R and Python interfaces aim to make the tool accessible to the fast-growing community of R and Python users. Transmission, treatment and prevention of HIV infections in dynamic sexual networks are simulated by discrete events. A generic “intervention” event allows model parameters to be changed over time, and can be used to model medical and behavioural HIV prevention programmes. First, we describe a more efficient variant of the modified Next Reaction Method that drives our continuous-time simulator. Next, we outline key built-in features and assumptions of individual-based models formulated in SimpactCyan, and provide code snippets for how to formulate, execute and analyse models in SimpactCyan through its R and Python interfaces. Lastly, we give two examples of applications in HIV epidemiology: the first demonstrates how the software can be used to estimate the impact of progressive changes to the eligibility criteria for HIV treatment on HIV incidence. The second example illustrates the use of SimpactCyan as a data-generating tool for assessing the performance of a phylodynamic inference framework.

Estimating the impact of antiretroviral therapy on HIV-TB co-infection: Optimal strategy prediction

2020 ◽  
pp. 2150004
Author(s):  
Tanvi ◽  
Rajiv Aggarwal
Keyword(s):  
Optimal Control ◽  
Equilibrium Point ◽  
Treatment Strategies ◽  
Hiv Treatment ◽  
Time Dependent ◽  
Control Parameters ◽  
Treatment Rate ◽  
Tb Treatment ◽  
The Cost ◽  
The Impact

In this paper, a nonlinear population model for HIV-TB co-infection has been proposed. The model is incorporated with the effect of early and late initiation of HIV treatment in co-infectives already on TB treatment, on the occurrence of Immune Reconstitution Inflammatory syndrome (IRIS). A 15-dimensional (15D) mathematical model has been developed in this study. We begin with considering constant treatment rates and thereafter, proceed to time-dependent treatment rates for co-infectives as control parameters. The basic reproduction number, a threshold quantity, corresponding to each HIV and TB sub-model has been computed in case of constant controls. With constant values of control parameters, mathematical analysis shows the existence and local stability of the disease-free equilibrium point and the endemic equilibrium point for the model. Together with time-dependent parameters, an optimal control problem is introduced and solved using Pontryagin’s maximum principle with an objective to minimize the number of infectives and disease induced deaths along with the cost of treatment. Numerical simulations are performed to examine the effect of reproduction numbers on control profiles and to identify, the ideal combination of treatment strategies which provides minimum burden on a society. Numerical results imply that if both HIV and TB are endemic in the population, then in order to bring in minimum burden from the co-infection, optimal control efforts must be enforced rather than constant treatment rate.

scholarly journals Impact of antibiotic resistance on outcomes of neutropenic cancer patients withPseudomonas aeruginosabacteraemia (IRONIC study): study protocol of a retrospective multicentre international study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e025744 ◽  
Author(s):  
Adaia Albasanz-Puig ◽  
Carlota Gudiol ◽  
Rocío Parody ◽  
Cristian Tebe ◽  
Murat Akova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Resistance ◽  
Cancer Patients ◽  
Case Fatality ◽  
International Study ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Personal Privacy ◽  
Haematological Patients ◽  
The Impact

IntroductionPseudomonas aeruginosa(PA) has historically been one of the major causes of severe sepsis and death among neutropenic cancer patients. There has been a recent increase of multidrug-resistant PA (MDRPA) isolates that may determine a worse prognosis, particularly in immunosuppressed patients. The aim of this study is to establish the impact of antibiotic resistance on the outcome of neutropenic onco-haematological patients with PA bacteraemia, and to identify the risk factors for MDRPA bacteraemia and mortality.Methods and analysisThis is a retrospective, observational, multicentre, international study. All episodes of PA bacteraemia occurring in neutropenic onco-haematological patients followed up at the participating centres from 1 January 2006 to 31 May 2018 will be retrospectively reviewed. The primary end point will be overall case-fatality rate within 30 days of onset of PA bacteraemia. The secondary end points will be to describe the following: the incidence and risk factors for multidrug-resistant and extremely drug-resistant PA bacteraemia (by comparing the episodes due to susceptible PA with those produced by MDRPA), the efficacy of ceftolozane/tazobactam, the rates of persistent bacteraemia and bacteraemia relapse and the risk factors for very early (48 hours), early (7 days) and overall (30 days) case-fatality rates.Ethics and disseminationThe Clinical Research Ethics Committee of Bellvitge University Hospital approved the protocol of the study at the primary site. To protect personal privacy, identifying information of each patient in the electronic database will be encrypted. The processing of the patients’ personal data collected in the study will comply with the Spanish Data Protection Act of 1998 and with the European Directive on the privacy of data. All data collected, stored and processed will be anonymised. Results will be reported at conferences and in peer-reviewed publications.

How social stigma sustains the HIV treatment gap for MSM in Mpumalanga, South Africa

2017 ◽  
Vol 26 (4) ◽  
pp. 6-13 ◽  
Author(s):  
Kabelo Maleke ◽  
Joseph Daniels ◽  
Tim Lane ◽  
Helen Struthers ◽  
James McIntyre ◽  
...  
Keyword(s):  
South Africa ◽  
Social Stigma ◽  
Clinical Care ◽  
Traditional Healers ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Care Seeking ◽  
Mpumalanga Province ◽  
Sex With Men ◽  
The Impact

There are gaps in HIV care for men who have sex with men (MSM) in African settings, and HIV social stigma plays a significant role in sustaining these gaps. We conducted a three-year research project with 49 HIV-positive MSM in two districts in Mpumalanga Province, South Africa, to understand the factors that inform HIV care seeking behaviors. Semi-structured focus group discussions and interviews were conducted in IsiZulu, SiSwati, and some code-switching into English, and these were audio-recorded, transcribed, and translated into English. We used a constant comparison approach to analyze these data. HIV social stigma centered around gossip that sustained self-diagnosis and delayed clinical care with decisions to use traditional healers to mitigate the impact of gossip on their lives. More collaboration models are needed between traditional healers and health professionals to support the global goals for HIV testing and treatment.

scholarly journals The impact of the stratification by degree of clinical severity and abandonment risk of tuberculosis treatment

2021 ◽  
pp. e20210018
Author(s):  
Pedro Daibert de Navarro1,2 ◽  
João Paulo Amaral Haddad3 ◽  
Juliana Veiga Costa Rabelo1 ◽  
Claudia Hermínia de Lima e Silva4 ◽  
Isabela Neves de Almeida2,5 ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intervention Group ◽  
Total Sample ◽  
Clinical Severity ◽  
Tuberculosis Treatment ◽  
Kaplan Meier ◽  
Belo Horizonte ◽  
Treatment Abandonment ◽  
The Impact ◽  
The City

Objective: Evaluate the impact of the instrument of the "Stratification by Degree of Clinical Severity and Abandonment Risk of Tuberculosis Treatment" (SRTB) on the tuberculosis outcome. Methods: This study was a pragmatic clinical trial involving patients with a confirmed diagnosis of tuberculosis treated at one of the 152 primary health care units in the city of Belo Horizonte, Brazil, between May of 2016 and April of 2017. Cluster areas for tuberculosis were identified, and the units and their respective patients were divided into intervention (use of SRTB) and nonintervention groups. Results: The total sample comprised 432 participants, 223 and 209 of whom being allocated to the nonintervention and intervention groups, respectively. The risk of treatment abandonment in the nonintervention group was significantly higher than was that in the intervention group (OR = 15.010; p < 0.001), regardless of the number of risk factors identified. Kaplan-Meier curves showed a hazard ratio of 0.0753 (p < 0.001). Conclusions: The SRTB instrument was effective in reducing abandonment of tuberculosis treatment, regardless of the number of risk factors for that. This instrument is rapid and easy to use, and can be adapted to different realities. Its application showed characteristics predisposing to a non-adherence to the treatment and established bases to mitigate its impact.

scholarly journals The impact of hypertension and use of calcium channel blockers on tuberculosis treatment outcomes

2020 ◽  
Author(s):  
Vignesh Chidambaram ◽  
Akshay Gupte ◽  
Jann-Yuan Wang ◽  
Jonathan Golub ◽  
Petros Karakousis
Keyword(s):  
Calcium Channel ◽  
Treatment Outcomes ◽  
Calcium Channel Blockers ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Channel Blockers ◽  
Tb Treatment ◽  
All Cause Mortality ◽  
The Impact ◽  
Related Mortality

Background: Hypertension induces systemic inflammation, but its impact on the outcome of infectious diseases like tuberculosis (TB) is unknown. Calcium channel blockers (CCB) improve TB treatment outcomes in pre-clinical models, but their effect in patients with TB remain unclear. Methods: This retrospective cohort study, including all patients > 18 years receiving treatment for culture-confirmed, drug-sensitive TB from 2000 to 2016 at the National Taiwan University Hospital, assessed the association of hypertension and CCB use with all-cause and infection-related mortality during the first 9 months of TB treatment, as well as sputum-smear microscopy and sputum-culture positivity at 2 and 6 months. Results: 1052 of the 2894 patients (36.4%) had hypertension. Multivariable analysis revealed that hypertension was associated with increased mortality due to all causes (HR 1.57, 95% confidence interval[CI], 1.23-1.99) and infections (HR 1.87, 95%CI, 1.34-2.6), but there was no statistical difference in microbiological outcomes when stratified based on hypertensive group. Dihydropyridine-CCB (DHP-CCB) use was associated with reduced all-cause mortality (HR 0.67, 95%CI: 0.45-0.98) only by univariate Cox regression. There was no association between DHP-CCB use and infection-related mortality (HR 0.78, 95%CI: 0.46-1.34) or microbiological outcomes in univariate or multivariate regression analyses. Conclusions: Patients with hypertension have increased all-cause mortality and infection-related mortality during the 9 months following TB treatment initiation. DHP-CCB use may lower all-cause mortality in TB patients with hypertension. The presence of hypertension or the use of CCB did not result in a significant change in microbiological outcomes. Keywords: Tuberculosis, hypertension, calcium channel blockers, mortality, treatment outcomes

scholarly journals Identifying missed opportunities for early intervention among HIV-infected paediatric admissions at Chris Hani Baragwanath hospital, Soweto, South Africa

2011 ◽  
Vol 12 (4) ◽  
pp. 16 ◽  
Author(s):  
Angela Dramowski ◽  
Ashraf Coovadia ◽  
Tammy Meyers ◽  
Ameena Goga
Keyword(s):  
South Africa ◽  
Early Intervention ◽  
Case Fatality ◽  
Hiv Disease ◽  
Eligibility Criteria ◽  
Missed Opportunities ◽  
Childhood Morbidity ◽  
Group 12 ◽  
Polymerase Chain ◽  
Advanced Hiv Disease

Background and design. HIV is a major contributor to childhood morbidity and mortality in South Africa. We describe HIV prevalence, disease profile, outcome and missed opportunities for early intervention in a cohort of HIV-infected children admitted to Chris Hani Baragwanath Hospital’s general paediatric wards between 1 October and 31 December 2007. Results. Of 1 510 admissions, 446 (29.5%) were HIV-infected. Many children (238, 54.1%) were newly diagnosed in hospital and most had advanced HIV disease (405, 92%). The principal admission diagnoses were pneumonia (165, 37.5%), gastro-enteritis (97, 22%), sepsis (86, 19.5%) and tuberculosis (92, 21%). Of children identified as HIV infected before admission, 128/202 (63.4%) were not accessing antiretroviral treatment (ART), although 121/128 (94.5%) met ART eligibility criteria. Of 364 ART-naïve eligible children, only 15 (4.1%) were commenced on ART as inpatients. Problems with PMTCT implementation in infants under 6 months (N=166) included lack of maternal antenatal HIV testing (51, 30.7%); poor uptake of maternal/infant nevirapine prophylaxis (60, 36.2%); limited use of co-trimoxazole (CTX) prophylaxis (44/147, 29.9%); and delayed infant HIV polymerase chain reaction testing (98/147, 87.5%). Of infants known to be HIV infected prior to hospitalisation, 37/51 (73%) had not initiated ART. The in-hospital case fatality rate (CFR) among HIV-infected children was triple that of the combined HIV-uninfected, exposed and unknown group (12% v. 3.6%). Infants

scholarly journals The epidemiology of musculoskeletal injuries in trail runners in the eThekwini Municipality of KwaZulu-Natal

2019 ◽  
Author(s):  
◽  
Maxine-Lee Millar
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Statistical Analysis ◽  
Informed Consent ◽  
Musculoskeletal Injuries ◽  
Informed Consent Form ◽  
Kwazulu Natal ◽  
Associated Risk Factors ◽  
The Impact ◽  
Trail Running

AIM: The aim of this study was to determine the point and period prevalence of musculoskeletal injuries, the injury profile, associated risk factors and the impact of musculoskeletal injuries on trail runners who participated in selected trail races in the eThekwini municipality of KwaZulu-Natal. SUBJECTS: Participants from various trail running races volunteered to participate in the study after the completion of a trail race. METHODOLOGY: Participants were approached individually following the completion of a minimum of a 10 kilometre trail race. Each participant read a letter of information and signed an informed consent form before completing the questionnaire. A total of 197 completed informed consent and post-pilot questionnaires were collected and placed in separate sealed ballot boxes. A code was allocated to each questionnaire before data was captured on a spreadsheet for statistical analysis. RESULTS: In total, 145 questionnaires were statistically analysed. The results revealed that only ethnicity and how often the participant's trail ran per month were significant predictors of developing an injury. White participants were five times more likely to be injured compared to African participants and those who ran more than 10 times a month were 4.65 times more likely to be injured than those who ran less than five times a month. The most common past injuries sustained by trail runners was shown to be predominantly due to trauma, and were located in the knee, ankles and ITB regions. Current injuries were shown to be equally due to trauma and overuse, with predominant location being in the same anatomical regions as past injuries. CONCLUSION: The majority of the data collected was in line with the literature on running; however, most of those studies were done on road runners. The findings of this study were unique to trail runners in KwaZulu-Natal. Further studies are required on trail runners in other regions of South Africa to determine a clearer injury profile.

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