Cardiovascular Risk among Patients with Drug-Resistant Tuberculosis and HIV in South Africa
Review TypeNone: Sigma Grant Recipient Report
Repository Posting Date2018-05-10T16:36:25Z
Author(s)Whitehouse, Erin Rachel
Author DetailsErin Whitehouse, PhD, MPH, RN email: email@example.com
Lead Author Sigma AffliationNu Beta
Level of EvidenceCohort Study
Research ApproachQuantitative Research
Keywordstuberculosis; drug-resistance; Cardiovascular Risk; Cardiovascular Risk Factors; Smoking; HIV
CINAHL HeadingsAIDS-Related Opportunistic Infections; Drug Resistance; Mycobacterium Tuberculosis; AIDS Patients; Acquired Immunodeficiency Syndrome; HIV Infections--Prevention and Control--South Africa; Cardiovascular Risk Factors--Evaluation; HIV Infections--Prevention and Control; HIV Infections; South Africa
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.
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.
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.
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.
Funder(s)National Institute of Allergy and Infectious Disease; Ruth L. Kirschstein National Research Service Award; Sigma Foundation for Nursing
DescriptionFunding 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)
Degree GrantorJohns Hopkins University
Date of Publication2018-05-10
NotesThe 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.
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