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Volume 26, Number 12—December 2020
CME ACTIVITY - Research

Tuberculosis among Children and Adolescents at HIV Treatment Centers in Sub-Saharan Africa

Anna M. Mandalakas1Comments to Author , Alexander W. Kay1, Jason M. Bacha, Tara Devezin, Rachel Golin, Katherine R. Simon, Dilsher Dhillon, Sandile Dlamini, Andrew DiNardo, Mogo Matshaba, Jill Sanders, Lineo Thahane, Pauline M. Amuge, Saeed Ahmed, Moorine P. Sekadde, Neway G. Fida, Bhekumusa Lukhele, Nodumo Chidah, David Damba, Joseph Mhango, Moses Chodota, Makhorong Matsoso, Angelina Kayabu, Richard S. Wanless, and Gordon E. Schutze
Author affiliations: Texas Children’s Hospital, Houston, Texas, USA (A.M. Manadalakas, A.W. Kay, J.M. Bacha, T. Devezin, K.R. Simon, D. Dhillon, S. Dlamini, A. DiNardo, M. Matshaba, J. Sanders, L. Thahane, S. Ahmed, N. Chidah, D. Damba, M. Chodota, M. Matsoso, A. Kayabu, R.S. Wanless, G.E. Schutze); Baylor College of Medicine, Houston (A.M. Manadalakas, A.W. Kay, J.M. Bacha, T. Devezin, D. Dhillon, A. DiNardo, B. Lukhele, R.S. Wanless, G.E. Schutze); Baylor College of Medicine Children’s Foundation Swaziland, Mbabane, Swaziland (A.W. Kay, S. Dlamini, B. Lukhele); Baylor College of Medicine Children's Foundation Tanzania, Mbeya, Tanzania (J.M. Bacha); US Agency for International Development, Washington, DC, USA (R. Golin); Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi (K.R. Simon, S. Ahmed, J. Mhango); Technical Support to PEPFAR Programs in the Southern Africa Region, Lilongwe (K.R. Simon, S. Ahmed, J. Mhango); Botswana-Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana (M. Matshaba, N. Chidah); Baylor College of Medicine Children’s Foundation Lesotho, Maseru, Lesotho (J. Sanders, L. Thahane, M. Matsoso); Baylor College of Medicine Children’s Foundation Uganda, Kampala, Uganda (P.M. Amuge, D. Damba); National Tuberculosis and Leprosy Programme, Kampala, Uganda (M.P. Sekkade); US Agency for International Development, Pretoria, South Africa (N.G. Fida); Baylor College of Medicine Children’s Foundation Tanzania, Mwanza, Tanzania (M. Chodota, A. Kayabu)

Main Article

Table 2

Bivariate analysis of associations with TB treatment outcomes in HIV-infected children and adolescents, 2013–2017*

Variable Outcome
 p value†
Total Completed TB treatment or cured Died Lost to follow up or transferred out
Sex 0.98
F 591 (50.95) 438 (51.11) 61 (50.41) 92 (50.55)
M
 569 (49.05)
 419 (48.89)
 60 (49.59)
 90 (49.45)
HIV treatment center <0.01
Botswana 33 (2.84) 31 (3.62) 0 2 (1.10)
Eswatini 365 (32.39) 302 (35.24) 15 (12.40) 48 (26.37)
Lesotho 38 (4.99) 33 (3.85) 3 (2.48) 2 (1.10)
Malawi 158 (13.62) 134 (15.64) 15 (12.40) 9 (4.95)
Tanzania–Mbeya 248 (21.38) 160 (18.67) 41 (33.88) 47 (25.82)
Tanzania–Mwanza 181 (15.60) 106 (12.37) 18 (14.88) 57 (31.32)
Uganda
 137 (11.81)
 91 (10.62)
 29 (23.97)
 17 (9.34)
Site of TB <0.01
Pulmonary TB 997 (88.39) 760 (90.15) 87 (78.38) 150 (86.21)
Extrapulmonary TB
 131 (11.61)
 83 (9.85)
 24 (21.62)
 24 (13.79)
TB treatment category 0.08
Newly treated TB patient 1,007 (90.56) 764 (91.50) 96 (91.43) 147 (85.47)
Previously treated TB patient
 105 (9.44)
 71 (8.50)
 9 (8.57)
 25 (14.53)
TB drug resistance testing <0.01
Not tested 837 (75.61) 612 (73.38) 82 (78.10) 143 (90.51)
Not detected 258 (23.31) 220 (26.38) 23 (21.70) 15 (9.04)
Mono-resistance detected 6 (0.54) 2 (0.24) 1 (0.94) 3 (1.81)
Multidrug-resistance detected
 6 (0.54)
 0
 0
 5 (3.01)
ART regimen at start of TB treatment 0.41
Efavirenz-based 225 (40.61) 177 (42.34) 20 (31.75) 28 (38.36)
Nevirapine-based 166 (29.96) 130 (31.10) 16 (25.40) 20 (27.40)
Lopinavir-based 134 (24.19) 91 (21.77) 23 (36.51) 20 (27.40)
Atazanavir-based 17 (3.07) 12 (2.87) 3 (4.76) 2 (2.74)
Other 9 (1.62) 6 (1.44) 1 (1.59) 2 (2.74)
Azidothymidine + lamivudine + abacavir
 3 (0.54)
 2 (0.48)
 0
 1 (1.37)
ART relative to start of TB treatment <0.01
On ART >6 mos 421 (34.59) 327 (36.01) 42 (34.71) 52 (27.66)
On ART <8 wks after TB treatment 396 (32.54) 315 (34.69) 26 (21.49) 55 (29.26)
On ART <6 mos 276 (22.68) 190 (20.93) 38 (31.40) 48 (25.53)
Never started ART 97 (7.97) 58 (6.39) 12 (9.92) 27 (14.36)
On ART >8 wks after TB treatment
 27 (2.22)
 18 (1.98)
 3 (2.48)
 6 (3.19)
Immune status at start of TB treatment <0.01
Nonadvanced 468 (55.19) 387 (58.46) 15 (22.73) 66 (55.00)
Severe 252 (29.72) 174 (26.28) 41 (62.12) 37 (30.83)
Advanced
 128 (15.09)
 101 (15.26)
 10 (15.15)
 17 (14.17)
Mean time receiving care before TB diagnosis, d 635.5 363.3 342 <0.01
Mean time on ART before TB diagnosis, d
 697.6 624 508.6 0.12

*Values are no (%) except as indicated. ART, antiretroviral therapy; TB, tuberculosis.
†χ2 test.

Main Article

1These authors contributed equally to this article.

Page created: September 10, 2020
Page updated: December 01, 2020
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