A new health care index predicts short term mortality for TB and HIV co-infected people. International Journal of Tuberculosis and Lung
Roen et al. aimed to re-evaluate a previously generated health care index (HCI) in a prospective cohort of tuberculosis (TB-) HIV co-infected individuals and to asses if additional factors, which parallel recent changes in TB-HIV health care management, predict mortality. They evaluated nine aspects of health care in Cox proportional hazards models on time from TB diagnosis to death.
Of 1’396 eligible individuals (72% male, 59% from Eastern Europe), 269 died within 12 months. Use of rifamycin/isoniazid/pyrazinamide based treatment (HR 0.67, 95% CI 0.50–0.89), TB drug susceptibility testing (DST) and number of active TB drugs (DST + <3 drugs (HR 1.09, 95% CI 0.80–1.48), DST + ≥3 drugs (HR 0.49, 95% CI 0.35–0.70) vs. no DST), recent HIV-RNA measurement (HR 0.64, 95% CI 0.50–0.82) and combination antiretroviral therapy use (HR 0.72, 95% CI 0.53–0.97) were associated with mortality. These factors contributed respectively 5, –1, 8, 5 and 4 to the HCI. Lower HCI was associated with an increased probability of death; 30% (95% CI 26–35) vs. 9% (95% CI 6–13) in the lowest vs. the highest quartile.
In conclusion, the authors improved their previous HCI to reflect recent changes in health care practices that predict 12-month mortality, even after adjusting for factors known to be associated with mortality among TB-HIV-positive individuals. The HCI has value in both high- and middle-income settings in Western and Eastern Europe, as well as Latin America. The proposed model suggests that five simple factors can be used to improve mortality among TB-HIV-positive individuals and to benchmark clinics and serve as a guide to improved health care provision to people with HIVTB.