Factors associated with mortality in persons co-infected with tuberculosis and HIV in Suriname: a retrospective cohort study.

ABSTRACT

OBJECTIVE: To identify socio-demographic and clinical factors associated with mortality among persons with tuberculosis (TB) and TB/HIV co-infection in Suriname. METHODS: This was a retrospective cohort study using data from the national TB and HIV databases for 2010 - 2015. The survival probability of TB and TB/HIV co-infected patients was analyzed using the Kaplan-Meier estimates and the log-rank test. A Cox proportional hazard model was applied. RESULTS: The study showed that HIV-seropositivity (aHR 2.08, 95%CI 1.48 - 2.92) and older age (aHR 5.84, 95%CI 3.00 - 11.4) are statistically associated with higher mortality. For the TB/HIV co-infected patients, TB treatment (aHR 0.43, 95%CI 0.35 - 0.53) reduces the risk of death. Similarly, HIV treatment started within 56 days (aHR 0.15, 95%CI 0.12 - 0.19) and delayed (aHR 0.25, 95%CI 0.13 - 0.47) result in less hazard for mortality; Directly-Observed Treatment (aOR 0.16, 95%CI 0.09 - 0.29) further reduces the risk. CONCLUSIONS: The Ministry of Health of Suriname should develop strategies for early case-finding in key populations, such as for HIV and TB in men 60 years of age and older. Implementation of Isoniazid Preventive Therapy for HIV should be pursued. Scaling up TB and HIV treatment, preferably through supervision, are essential to reducing the TB/HIV mortality.