Impact of three empirical anti-tuberculosis treatment strategies for people initiating antiretroviral therapy

Van Rie, A.; Westreich, D.; Sanne, I.

doi:10.5588/IJTLD.14.0153

Title

Impact of three empirical anti-tuberculosis treatment strategies for people initiating antiretroviral therapy

Author

Van Rie, A.

Westreich, D.

Sanne, I.

Abstract

BACKGROUND: Early mortality in people initiating antiretroviral treatment (ART) remains high. Empirical anti-tuberculosis treatment strategies aim to reduce early mortality by initiating anti-tuberculosis treatment in individuals at high risk of death from undiagnosed TB. METHODS: Using data from 16 913 individuals starting ART under program conditions, we simulated the impact of three empirical treatment strategies (two clinical trials and a pragmatic approach), assuming that 50% of early deaths and 100% of incident TB are averted in those eligible. RESULTS: Compared to starting anti-tuberculosis treatment on clinical or mycobacteriological grounds, 4.4-31.4% more individuals were eligible for anti-tuberculosis treatment, 5.5-25.4% of deaths were averted and 10.9-57.3% of incident TB cases were prevented under empirical anti-tuberculosis treatment strategies. The proportion receiving any anti-tuberculosis treatment during the first 6 months of ART increased from the observed 24.0% to an estimated 27.5%, 40.4% and 51.3%, under the PrOMPT, REMEMBER and pragmatic approach, respectively. CONCLUSION: The impact of empirical anti-tuberculosis treatment strategies depends greatly on the eligibility criteria chosen. The additional strain placed on anti-tuberculosis treatment facilities and the relatively limited impact of some empirical TB strategies raise the question as to whether the benefits will outweigh the risks at population level.

Language

English

Source (journal)

International journal of tuberculosis and lung disease. - Paris

Publication

Paris : 2014

ISSN

1027-3719

DOI

10.5588/IJTLD.14.0153

Volume/pages

18 :11 (2014) , p. 1340-1346