Introduction TB-HIV co-infected patients have worse treatment outcomes than non-coinfected patients. How clinical characteristics of TB and patient socioeconomic characteristics influence these outcomes is poorly understood. We identified clinical and epidemiological characteristics associated with unfavourable treatment outcomes in TB-HIV co-infected patients in Brazil.
Methods TB-HIV cases reported in the Brazilian information system (SINAN) between January 1, 2001 and December 31, 2011 were identified and categorised by TB treatment outcome (cure, default, death and development of MDR TB). We modelled treatment outcome as a function of clinical characteristics of TB and patient socioeconomic characteristics using polytomous regression. For each possible outcome (default, death from TB, death from other case, death from MDR-TB) the reference outcome was cure.
Results Patients aged 15–19 (OR = 2.86; 95% CI: 2.09–3.91) and 20–39 years old (OR = 2.30; 95% CI: 1.81–2.92) were more likely to default on TB treatment than those aged 0–14 years old. In contrast, patients aged ≥60 years were more likely to die from TB (OR = 2.22; 95% CI: 1.43–3.44) or other causes (OR = 2.86; 95% CI: 2.14–3.83). Black patients were more likely to default on TB treatment (OR = 1.33; 95% CI: 1.22–1.44) and die from TB (OR = 1.50; 95% CI: 1.29–1.74). Patients with ≥8 years of education were less likely to default on TB treatment (OR = 0.68; 95% CI: 0.63–0.74), die from TB (OR = 0.82; 95% CI: 0.71–0.94) and die from other causes (OR = 0.78; 95% CI: 0.71–0.84). Finally, alcoholism was associated with all unfavourable outcomes: default (OR = 1.94; 95% CI: 1.73–2.17), death due to TB (OR = 1.46; 95% CI: 1.25–1.71), death due to other causes (OR = 1.38; 95% CI: 1.21–1.57) and MDR-TB (OR = 2.29; 95% CI: 1.46–3.58).
Conclusion Socio-economic vulnerability has a significant effect on treatment outcomes among TB-HIV co-infected patients in Brazil. Enhancing social support and incorporation of alcohol abuse screening and counselling into current TB surveillance programs and targeting interventions to specific age groups are specific interventions that could improve treatment outcomes.
Disclosure of interest statement Nothing to declare.