Cardiovascular risk among patients with drug-resistant tuberculosis and HIV in South Africa
Erin R. Whitehouse, PhD, MPH, RN
- Sigma Affiliation
- Nu Beta at-Large
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Problem Statement: South Africa has the highest incidence of drug resistant-tuberculosis (DR-TB) in sub-Saharan Africa and outcomes are poor. Only 54% of patients successfully complete treatment. The prevalence of HIV co-infection and cardiovascular (CVD) risk factors is also increasing. The purpose of this study was to describe cardiovascular risk in DR-TB patients with and without HIV co-infection and the impact of this risk on 6-month DR-TB negative treatment outcomes among patients co-infected with HIV.
Methods: This prospective cohort study was nested within an ongoing cluster randomized trial of nurse case management in 10 DR-TB hospitals in Eastern Cape and KwaZulu-Natal, South Africa. The data were collected between November 2014 and July 2016. The prevalence of CVD risk factors and a non-laboratory based risk score were estimated, compared by HIV status, and used to explore the impact on DR-TB negative treatment outcome among 443 HIV co-infected patients.
Results: Of 900 participants, 53.7% were male, 75.1% were HIV co-infected, and 52.3% had at least one CVD risk factor. Males were more likely to have ever smoked (52.5% vs 7.3%, χ2=207.31, p2=50.97, p=35 years old, patients with a high or moderate CVD risk score were 4.5 times more likely to have an early negative treatment outcome compared with those with low CVD risk.
Conclusions: Except for BMI, individual CVD risk factors did not impact early DR-TB outcomes, although an elevated CVD score did increase risk of negative outcome. Providers should screen and treat patients with CVD risk factors according to evidence-based guidelines. Health systems should provide comprehensive, patient-centered care to improve both DR-TB outcomes and CVD related morbidity and mortality in low- and middle-income countries like South Africa.
Funding provided by: National Institute of Allergy and Infectious Disease, NIH R01 AI104488 (2014-2018); Ruth L. Kirschstein National Research Service Award [NRSA] Individual Predoctoral Fellowship from National Institute of Nursing Research, NIH F31-NR016909 (2016-2018); Sigma Theta Tau International Research Grant (2017-2018)
The Sigma Theta Tau International grant application that funded this research, in whole or in part, was completed by the applicant and peer-reviewed prior to the award of the STTI grant. No further peer-review has taken place upon the completion of the STTI grant final report and its appearance in this repository.
|None: Sigma Grant Recipient Report
Cardiovascular Risk Factors;
|AIDS-Related Opportunistic Infections;
Acquired Immunodeficiency Syndrome;
HIV Infections--Prevention and Control--South Africa;
Cardiovascular Risk Factors--Evaluation;
HIV Infections--Prevention and Control;
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