Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients

Daria N. Podlekareva; D. Grint; F. A. Post; A. Mocroft; A. M. Panteleev; R. F. Miller; J. M. Miro; M. Bruyand; H. Furrer; V. Riekstina; E. Girardi; M. H. Losso; J. A. Caylá; E. A. Malashenkov; N. Obel; A. M. Skrahina; J. D. Lundgren; O. Kirk; N. Chentsova; D. Duiculesku; J. J. Toibaro; E. Warley; N. Tamayo; M. C. Ortiz; P. Scapelatto; E. Bottaro; F. Murano; M. Miachans; J. Contarelli; L. Massera; J. Corral; M. Hualde; C. Miglioranza; M. Corti; H. Metta; A. Casiró; R. Cuini; H. Laplume; D. David; C. Marson; S. Lupo; L. Trape; O. Garcia Messina; O. Gear; J. M. Bruguera; I. Karpov; A. Vasilenko; E. Skrahina; V. Mitsura; E. Kozorez; D. Ruzanov; V. Bondarenko; O. Suetnov; D. Paduto; F. Dabis; A. Matteelli; A. C. Carvalho; R. Basché; I. E. Hamad; B. A. Ricci; F. Maggiolo; V. Ravasio; C. Mussini; F. Prati; S. Castelletti; L. Spallanzani; A. Antinori; G. Antonucci; C. Bibbolino; G. Bove; E. Busi Rizzi; S. Cicalini; A. Conte; G. Cuzzi; P. De Mori; A. Festa; D. Goletti; S. Grisetti; G. Gualano; F. N. Lauria; R. Maddaluno; P. Migliorisi Ramazzini; P. Narciso; L. Parracino; F. Palmieri; N. Petrosillo; L. Pucillo; V. Puro; P. Vanacore; R. Urso; P. Aldins; I. Zeltina; D. Duiculescu; A. Rakhmanova; A. Kozlov; S. Buzunova; C. Manzardo; J. F. García-Goez; A. Moreno-Camacho; J. A. Martínez; J. González; F. García-Alcaide; I. Pérez; J. M. Gatell; P. Sánchez; J. L. López-Colomes Mutua de Terrassa; X. Martínez-Lacasa; V. F. Imaz; I. Ocaña; R. Vidal; M. A. Sambeat; A. Moreno-Martínez; J. P. Millet; L. Fina; L. del Baño; A. Orcau; J. Barth; M. Battegay; E. Bernasconi; J. Böni; H. C. Bucher; C. Burton-Jeangros; A. Calmy; M. Cavassini; C. Cellerai; M. Egger; L. Elzi; J. Fehr; J. Fellay; M. Flepp; C. A. Fux; M. Gorgievski; H. Günthard; D. Haerry; B. Hasse; H. H. Hirsch; B. Hirschel; I. Hösli; C. Kahlert; L. Kaiser; O. Keiser; C. Kind; T. Klimkait; H. Kovari; B. Ledergerber; G. Martinetti; B. Martinez de Tejada; K. Metzner; N. Müller; D. Nadal; G. Pantaleo; A. Rauch; S. Regenass; M. Rickenbach; C. Rudin; P. Schmid; D. Schultze; F. Schöni-Affolter; J. Schüpbach; R. Speck; P. Taffé; P. Tarr; A. Telenti; A. Trkola; P. Vernazza; R. Weber; S. Yerly; L. Campbell; A. Arenas-Pinto; J. Kjær; M. Ellefson; D. Duiculesku

doi:10.5588/ijtld.12.0224

Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients

Daria N. Podlekareva, D. Grint, F. A. Post, A. Mocroft, A. M. Panteleev, R. F. Miller, J. M. Miro, M. Bruyand, H. Furrer, V. Riekstina, E. Girardi, M. H. Losso, J. A. Caylá, E. A. Malashenkov, N. Obel, A. M. Skrahina, J. D. Lundgren, O. Kirk, N. Chentsova, D. DuiculeskuJ. J. Toibaro, E. Warley, N. Tamayo, M. C. Ortiz, P. Scapelatto, E. Bottaro, F. Murano, M. Miachans, J. Contarelli, L. Massera, J. Corral, M. Hualde, C. Miglioranza, M. Corti, H. Metta, A. Casiró, R. Cuini, H. Laplume, D. David, C. Marson, S. Lupo, L. Trape, O. Garcia Messina, O. Gear, J. M. Bruguera, I. Karpov, A. Vasilenko, E. Skrahina, V. Mitsura, E. Kozorez, D. Ruzanov, V. Bondarenko, O. Suetnov, D. Paduto, F. Dabis, A. Matteelli, A. C. Carvalho, R. Basché, I. E. Hamad, B. A. Ricci, F. Maggiolo, V. Ravasio, C. Mussini, F. Prati, S. Castelletti, L. Spallanzani, A. Antinori, G. Antonucci, C. Bibbolino, G. Bove, E. Busi Rizzi, S. Cicalini, A. Conte, G. Cuzzi, P. De Mori, A. Festa, D. Goletti, S. Grisetti, G. Gualano, F. N. Lauria, R. Maddaluno, P. Migliorisi Ramazzini, P. Narciso, L. Parracino, F. Palmieri, N. Petrosillo, L. Pucillo, V. Puro, P. Vanacore, R. Urso, P. Aldins, I. Zeltina, D. Duiculescu, A. Rakhmanova, A. Kozlov, S. Buzunova, C. Manzardo, J. F. García-Goez, A. Moreno-Camacho, J. A. Martínez, J. González, F. García-Alcaide, I. Pérez, J. M. Gatell, P. Sánchez, J. L. López-Colomes Mutua de Terrassa, X. Martínez-Lacasa, V. F. Imaz, I. Ocaña, R. Vidal, M. A. Sambeat, A. Moreno-Martínez, J. P. Millet, L. Fina, L. del Baño, A. Orcau, J. Barth, M. Battegay, E. Bernasconi, J. Böni, H. C. Bucher, C. Burton-Jeangros, A. Calmy, M. Cavassini, C. Cellerai, M. Egger, L. Elzi, J. Fehr, J. Fellay, M. Flepp, C. A. Fux, M. Gorgievski, H. Günthard, D. Haerry, B. Hasse, H. H. Hirsch, B. Hirschel, I. Hösli, C. Kahlert, L. Kaiser, O. Keiser, C. Kind, T. Klimkait, H. Kovari, B. Ledergerber, G. Martinetti, B. Martinez de Tejada, K. Metzner, N. Müller, D. Nadal, G. Pantaleo, A. Rauch, S. Regenass, M. Rickenbach, C. Rudin, P. Schmid, D. Schultze, F. Schöni-Affolter, J. Schüpbach, R. Speck, P. Taffé, P. Tarr, A. Telenti, A. Trkola, P. Vernazza, R. Weber, S. Yerly, L. Campbell, A. Arenas-Pinto, J. Kjær, M. Ellefson, D. Duiculesku

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

OBJECTIVES: To assess health care utilisation for patients co-infected with TB and HIV (TB-HIV), and to develop a weighted health care index (HCI) score based on commonly used interventions and compare it with patient outcome. METHODS: A total of 1061 HIV patients diagnosed with TB in four regions, Central/Northern, Southern and Eastern Europe and Argentina, between January 2004 and December 2006 were enrolled in the TB-HIV study. A weighted HCI score (range 0-5), based on independent prognostic factors identified in multivariable Cox models and the final score, included performance of TB drug susceptibility testing (DST), an initial TB regimen containing a rifamycin, isoniazid and pyrazinamide, and start of combination antiretroviral treatment (cART). RESULTS: The mean HCI score was highest in Central/Northern Europe (3.2, 95%CI 3.1-3.3) and lowest in Eastern Europe (1.6, 95%CI 1.5-1.7). The cumulative probability of death 1 year after TB diagnosis decreased from 39% (95%CI 31-48) among patients with an HCI score of 0, to 9% (95%CI 6-13) among those with a score of ≥4. In an adjusted Cox model, a 1-unit increase in the HCI score was associated with 27% reduced mortality (relative hazard 0.73, 95%CI 0.64-0.84). CONCLUSIONS: Our results suggest that DST, standard anti-tuberculosis treatment and early cART may improve outcome for TB-HIV patients. The proposed HCI score provides a tool for future research and monitoring of the management of TB-HIV patients. The highest HCI score may serve as a benchmark to assess TB-HIV management, encouraging continuous health care improvement.

Original language	English (US)
Pages (from-to)	198-206+i
Journal	International Journal of Tuberculosis and Lung Disease
Volume	17
Issue number	2
DOIs	https://doi.org/10.5588/ijtld.12.0224
State	Published - Feb 1 2013
Externally published	Yes

Keywords

Health care index score
Outcome of TB-HIV patients
TB-HIV co-infection
TB-HIV health care utilisation

ASJC Scopus subject areas

General Medicine

Access to Document

10.5588/ijtld.12.0224

Cite this

Podlekareva, D. N., Grint, D., Post, F. A., Mocroft, A., Panteleev, A. M., Miller, R. F., Miro, J. M., Bruyand, M., Furrer, H., Riekstina, V., Girardi, E., Losso, M. H., Caylá, J. A., Malashenkov, E. A., Obel, N., Skrahina, A. M., Lundgren, J. D., Kirk, O., Chentsova, N., ... Duiculesku, D. (2013). Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients. International Journal of Tuberculosis and Lung Disease, 17(2), 198-206+i. https://doi.org/10.5588/ijtld.12.0224

Podlekareva, DN, Grint, D, Post, FA, Mocroft, A, Panteleev, AM, Miller, RF, Miro, JM, Bruyand, M, Furrer, H, Riekstina, V, Girardi, E, Losso, MH, Caylá, JA, Malashenkov, EA, Obel, N, Skrahina, AM, Lundgren, JD, Kirk, O, Chentsova, N, Duiculesku, D, Toibaro, JJ, Warley, E, Tamayo, N, Ortiz, MC, Scapelatto, P, Bottaro, E, Murano, F, Miachans, M, Contarelli, J, Massera, L, Corral, J, Hualde, M, Miglioranza, C, Corti, M, Metta, H, Casiró, A, Cuini, R, Laplume, H, David, D, Marson, C, Lupo, S, Trape, L, Garcia Messina, O, Gear, O, Bruguera, JM, Karpov, I, Vasilenko, A, Skrahina, E, Mitsura, V, Kozorez, E, Ruzanov, D, Bondarenko, V, Suetnov, O, Paduto, D, Dabis, F, Matteelli, A, Carvalho, AC, Basché, R, Hamad, IE, Ricci, BA, Maggiolo, F, Ravasio, V, Mussini, C, Prati, F, Castelletti, S, Spallanzani, L, Antinori, A, Antonucci, G, Bibbolino, C, Bove, G, Busi Rizzi, E, Cicalini, S, Conte, A, Cuzzi, G, De Mori, P, Festa, A, Goletti, D, Grisetti, S, Gualano, G, Lauria, FN, Maddaluno, R, Migliorisi Ramazzini, P, Narciso, P, Parracino, L, Palmieri, F, Petrosillo, N, Pucillo, L, Puro, V, Vanacore, P, Urso, R, Aldins, P, Zeltina, I, Duiculescu, D, Rakhmanova, A, Kozlov, A, Buzunova, S, Manzardo, C, García-Goez, JF, Moreno-Camacho, A, Martínez, JA, González, J, García-Alcaide, F, Pérez, I, Gatell, JM, Sánchez, P, López-Colomes Mutua de Terrassa, JL, Martínez-Lacasa, X, Imaz, VF, Ocaña, I, Vidal, R, Sambeat, MA, Moreno-Martínez, A, Millet, JP, Fina, L, del Baño, L, Orcau, A, Barth, J, Battegay, M, Bernasconi, E, Böni, J, Bucher, HC, Burton-Jeangros, C, Calmy, A, Cavassini, M, Cellerai, C, Egger, M, Elzi, L, Fehr, J, Fellay, J, Flepp, M, Fux, CA, Gorgievski, M, Günthard, H, Haerry, D, Hasse, B, Hirsch, HH, Hirschel, B, Hösli, I, Kahlert, C, Kaiser, L, Keiser, O, Kind, C, Klimkait, T, Kovari, H, Ledergerber, B, Martinetti, G, Martinez de Tejada, B, Metzner, K, Müller, N, Nadal, D, Pantaleo, G, Rauch, A, Regenass, S, Rickenbach, M, Rudin, C, Schmid, P, Schultze, D, Schöni-Affolter, F, Schüpbach, J, Speck, R, Taffé, P, Tarr, P, Telenti, A, Trkola, A, Vernazza, P, Weber, R, Yerly, S, Campbell, L, Arenas-Pinto, A, Kjær, J, Ellefson, M & Duiculesku, D 2013, 'Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients', International Journal of Tuberculosis and Lung Disease, vol. 17, no. 2, pp. 198-206+i. https://doi.org/10.5588/ijtld.12.0224

@article{2320f25bc94d4491b1271f88825fb57f,

title = "Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients",

abstract = "OBJECTIVES: To assess health care utilisation for patients co-infected with TB and HIV (TB-HIV), and to develop a weighted health care index (HCI) score based on commonly used interventions and compare it with patient outcome. METHODS: A total of 1061 HIV patients diagnosed with TB in four regions, Central/Northern, Southern and Eastern Europe and Argentina, between January 2004 and December 2006 were enrolled in the TB-HIV study. A weighted HCI score (range 0-5), based on independent prognostic factors identified in multivariable Cox models and the final score, included performance of TB drug susceptibility testing (DST), an initial TB regimen containing a rifamycin, isoniazid and pyrazinamide, and start of combination antiretroviral treatment (cART). RESULTS: The mean HCI score was highest in Central/Northern Europe (3.2, 95%CI 3.1-3.3) and lowest in Eastern Europe (1.6, 95%CI 1.5-1.7). The cumulative probability of death 1 year after TB diagnosis decreased from 39% (95%CI 31-48) among patients with an HCI score of 0, to 9% (95%CI 6-13) among those with a score of ≥4. In an adjusted Cox model, a 1-unit increase in the HCI score was associated with 27% reduced mortality (relative hazard 0.73, 95%CI 0.64-0.84). CONCLUSIONS: Our results suggest that DST, standard anti-tuberculosis treatment and early cART may improve outcome for TB-HIV patients. The proposed HCI score provides a tool for future research and monitoring of the management of TB-HIV patients. The highest HCI score may serve as a benchmark to assess TB-HIV management, encouraging continuous health care improvement.",

keywords = "Health care index score, Outcome of TB-HIV patients, TB-HIV co-infection, TB-HIV health care utilisation",

author = "Podlekareva, {Daria N.} and D. Grint and Post, {F. A.} and A. Mocroft and Panteleev, {A. M.} and Miller, {R. F.} and Miro, {J. M.} and M. Bruyand and H. Furrer and V. Riekstina and E. Girardi and Losso, {M. H.} and Cayl{\'a}, {J. A.} and Malashenkov, {E. A.} and N. Obel and Skrahina, {A. M.} and Lundgren, {J. D.} and O. Kirk and N. Chentsova and D. Duiculesku and Toibaro, {J. J.} and E. Warley and N. Tamayo and Ortiz, {M. C.} and P. Scapelatto and E. Bottaro and F. Murano and M. Miachans and J. Contarelli and L. Massera and J. Corral and M. Hualde and C. Miglioranza and M. Corti and H. Metta and A. Casir{\'o} and R. Cuini and H. Laplume and D. David and C. Marson and S. Lupo and L. Trape and {Garcia Messina}, O. and O. Gear and Bruguera, {J. M.} and I. Karpov and A. Vasilenko and E. Skrahina and V. Mitsura and E. Kozorez and D. Ruzanov and V. Bondarenko and O. Suetnov and D. Paduto and F. Dabis and A. Matteelli and Carvalho, {A. C.} and R. Basch{\'e} and Hamad, {I. E.} and Ricci, {B. A.} and F. Maggiolo and V. Ravasio and C. Mussini and F. Prati and S. Castelletti and L. Spallanzani and A. Antinori and G. Antonucci and C. Bibbolino and G. Bove and {Busi Rizzi}, E. and S. Cicalini and A. Conte and G. Cuzzi and {De Mori}, P. and A. Festa and D. Goletti and S. Grisetti and G. Gualano and Lauria, {F. N.} and R. Maddaluno and {Migliorisi Ramazzini}, P. and P. Narciso and L. Parracino and F. Palmieri and N. Petrosillo and L. Pucillo and V. Puro and P. Vanacore and R. Urso and P. Aldins and I. Zeltina and D. Duiculescu and A. Rakhmanova and A. Kozlov and S. Buzunova and C. Manzardo and Garc{\'i}a-Goez, {J. F.} and A. Moreno-Camacho and Mart{\'i}nez, {J. A.} and J. Gonz{\'a}lez and F. Garc{\'i}a-Alcaide and I. P{\'e}rez and Gatell, {J. M.} and P. S{\'a}nchez and {L{\'o}pez-Colomes Mutua de Terrassa}, {J. L.} and X. Mart{\'i}nez-Lacasa and Imaz, {V. F.} and I. Oca{\~n}a and R. Vidal and Sambeat, {M. A.} and A. Moreno-Mart{\'i}nez and Millet, {J. P.} and L. Fina and {del Ba{\~n}o}, L. and A. Orcau and J. Barth and M. Battegay and E. Bernasconi and J. B{\"o}ni and Bucher, {H. C.} and C. Burton-Jeangros and A. Calmy and M. Cavassini and C. Cellerai and M. Egger and L. Elzi and J. Fehr and J. Fellay and M. Flepp and Fux, {C. A.} and M. Gorgievski and H. G{\"u}nthard and D. Haerry and B. Hasse and Hirsch, {H. H.} and B. Hirschel and I. H{\"o}sli and C. Kahlert and L. Kaiser and O. Keiser and C. Kind and T. Klimkait and H. Kovari and B. Ledergerber and G. Martinetti and {Martinez de Tejada}, B. and K. Metzner and N. M{\"u}ller and D. Nadal and G. Pantaleo and A. Rauch and S. Regenass and M. Rickenbach and C. Rudin and P. Schmid and D. Schultze and F. Sch{\"o}ni-Affolter and J. Sch{\"u}pbach and R. Speck and P. Taff{\'e} and P. Tarr and A. Telenti and A. Trkola and P. Vernazza and R. Weber and S. Yerly and L. Campbell and A. Arenas-Pinto and J. Kj{\ae}r and M. Ellefson and D. Duiculesku",

year = "2013",

month = feb,

day = "1",

doi = "10.5588/ijtld.12.0224",

language = "English (US)",

volume = "17",

pages = "198--206+i",

journal = "International Journal of Tuberculosis and Lung Disease",

issn = "1027-3719",

publisher = "International Union against Tubercul. and Lung Dis.",

number = "2",

}

TY - JOUR

T1 - Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients

AU - Podlekareva, Daria N.

AU - Grint, D.

AU - Post, F. A.

AU - Mocroft, A.

AU - Panteleev, A. M.

AU - Miller, R. F.

AU - Miro, J. M.

AU - Bruyand, M.

AU - Furrer, H.

AU - Riekstina, V.

AU - Girardi, E.

AU - Losso, M. H.

AU - Caylá, J. A.

AU - Malashenkov, E. A.

AU - Obel, N.

AU - Skrahina, A. M.

AU - Lundgren, J. D.

AU - Kirk, O.

AU - Chentsova, N.

AU - Duiculesku, D.

AU - Toibaro, J. J.

AU - Warley, E.

AU - Tamayo, N.

AU - Ortiz, M. C.

AU - Scapelatto, P.

AU - Bottaro, E.

AU - Murano, F.

AU - Miachans, M.

AU - Contarelli, J.

AU - Massera, L.

AU - Corral, J.

AU - Hualde, M.

AU - Miglioranza, C.

AU - Corti, M.

AU - Metta, H.

AU - Casiró, A.

AU - Cuini, R.

AU - Laplume, H.

AU - David, D.

AU - Marson, C.

AU - Lupo, S.

AU - Trape, L.

AU - Garcia Messina, O.

AU - Gear, O.

AU - Bruguera, J. M.

AU - Karpov, I.

AU - Vasilenko, A.

AU - Skrahina, E.

AU - Mitsura, V.

AU - Kozorez, E.

AU - Ruzanov, D.

AU - Bondarenko, V.

AU - Suetnov, O.

AU - Paduto, D.

AU - Dabis, F.

AU - Matteelli, A.

AU - Carvalho, A. C.

AU - Basché, R.

AU - Hamad, I. E.

AU - Ricci, B. A.

AU - Maggiolo, F.

AU - Ravasio, V.

AU - Mussini, C.

AU - Prati, F.

AU - Castelletti, S.

AU - Spallanzani, L.

AU - Antinori, A.

AU - Antonucci, G.

AU - Bibbolino, C.

AU - Bove, G.

AU - Busi Rizzi, E.

AU - Cicalini, S.

AU - Conte, A.

AU - Cuzzi, G.

AU - De Mori, P.

AU - Festa, A.

AU - Goletti, D.

AU - Grisetti, S.

AU - Gualano, G.

AU - Lauria, F. N.

AU - Maddaluno, R.

AU - Migliorisi Ramazzini, P.

AU - Narciso, P.

AU - Parracino, L.

AU - Palmieri, F.

AU - Petrosillo, N.

AU - Pucillo, L.

AU - Puro, V.

AU - Vanacore, P.

AU - Urso, R.

AU - Aldins, P.

AU - Zeltina, I.

AU - Duiculescu, D.

AU - Rakhmanova, A.

AU - Kozlov, A.

AU - Buzunova, S.

AU - Manzardo, C.

AU - García-Goez, J. F.

AU - Moreno-Camacho, A.

AU - Martínez, J. A.

AU - González, J.

AU - García-Alcaide, F.

AU - Pérez, I.

AU - Gatell, J. M.

AU - Sánchez, P.

AU - López-Colomes Mutua de Terrassa, J. L.

AU - Martínez-Lacasa, X.

AU - Imaz, V. F.

AU - Ocaña, I.

AU - Vidal, R.

AU - Sambeat, M. A.

AU - Moreno-Martínez, A.

AU - Millet, J. P.

AU - Fina, L.

AU - del Baño, L.

AU - Orcau, A.

AU - Barth, J.

AU - Battegay, M.

AU - Bernasconi, E.

AU - Böni, J.

AU - Bucher, H. C.

AU - Burton-Jeangros, C.

AU - Calmy, A.

AU - Cavassini, M.

AU - Cellerai, C.

AU - Egger, M.

AU - Elzi, L.

AU - Fehr, J.

AU - Fellay, J.

AU - Flepp, M.

AU - Fux, C. A.

AU - Gorgievski, M.

AU - Günthard, H.

AU - Haerry, D.

AU - Hasse, B.

AU - Hirsch, H. H.

AU - Hirschel, B.

AU - Hösli, I.

AU - Kahlert, C.

AU - Kaiser, L.

AU - Keiser, O.

AU - Kind, C.

AU - Klimkait, T.

AU - Kovari, H.

AU - Ledergerber, B.

AU - Martinetti, G.

AU - Martinez de Tejada, B.

AU - Metzner, K.

AU - Müller, N.

AU - Nadal, D.

AU - Pantaleo, G.

AU - Rauch, A.

AU - Regenass, S.

AU - Rickenbach, M.

AU - Rudin, C.

AU - Schmid, P.

AU - Schultze, D.

AU - Schöni-Affolter, F.

AU - Schüpbach, J.

AU - Speck, R.

AU - Taffé, P.

AU - Tarr, P.

AU - Telenti, A.

AU - Trkola, A.

AU - Vernazza, P.

AU - Weber, R.

AU - Yerly, S.

AU - Campbell, L.

AU - Arenas-Pinto, A.

AU - Kjær, J.

AU - Ellefson, M.

AU - Duiculesku, D.

PY - 2013/2/1

Y1 - 2013/2/1

N2 - OBJECTIVES: To assess health care utilisation for patients co-infected with TB and HIV (TB-HIV), and to develop a weighted health care index (HCI) score based on commonly used interventions and compare it with patient outcome. METHODS: A total of 1061 HIV patients diagnosed with TB in four regions, Central/Northern, Southern and Eastern Europe and Argentina, between January 2004 and December 2006 were enrolled in the TB-HIV study. A weighted HCI score (range 0-5), based on independent prognostic factors identified in multivariable Cox models and the final score, included performance of TB drug susceptibility testing (DST), an initial TB regimen containing a rifamycin, isoniazid and pyrazinamide, and start of combination antiretroviral treatment (cART). RESULTS: The mean HCI score was highest in Central/Northern Europe (3.2, 95%CI 3.1-3.3) and lowest in Eastern Europe (1.6, 95%CI 1.5-1.7). The cumulative probability of death 1 year after TB diagnosis decreased from 39% (95%CI 31-48) among patients with an HCI score of 0, to 9% (95%CI 6-13) among those with a score of ≥4. In an adjusted Cox model, a 1-unit increase in the HCI score was associated with 27% reduced mortality (relative hazard 0.73, 95%CI 0.64-0.84). CONCLUSIONS: Our results suggest that DST, standard anti-tuberculosis treatment and early cART may improve outcome for TB-HIV patients. The proposed HCI score provides a tool for future research and monitoring of the management of TB-HIV patients. The highest HCI score may serve as a benchmark to assess TB-HIV management, encouraging continuous health care improvement.

AB - OBJECTIVES: To assess health care utilisation for patients co-infected with TB and HIV (TB-HIV), and to develop a weighted health care index (HCI) score based on commonly used interventions and compare it with patient outcome. METHODS: A total of 1061 HIV patients diagnosed with TB in four regions, Central/Northern, Southern and Eastern Europe and Argentina, between January 2004 and December 2006 were enrolled in the TB-HIV study. A weighted HCI score (range 0-5), based on independent prognostic factors identified in multivariable Cox models and the final score, included performance of TB drug susceptibility testing (DST), an initial TB regimen containing a rifamycin, isoniazid and pyrazinamide, and start of combination antiretroviral treatment (cART). RESULTS: The mean HCI score was highest in Central/Northern Europe (3.2, 95%CI 3.1-3.3) and lowest in Eastern Europe (1.6, 95%CI 1.5-1.7). The cumulative probability of death 1 year after TB diagnosis decreased from 39% (95%CI 31-48) among patients with an HCI score of 0, to 9% (95%CI 6-13) among those with a score of ≥4. In an adjusted Cox model, a 1-unit increase in the HCI score was associated with 27% reduced mortality (relative hazard 0.73, 95%CI 0.64-0.84). CONCLUSIONS: Our results suggest that DST, standard anti-tuberculosis treatment and early cART may improve outcome for TB-HIV patients. The proposed HCI score provides a tool for future research and monitoring of the management of TB-HIV patients. The highest HCI score may serve as a benchmark to assess TB-HIV management, encouraging continuous health care improvement.

KW - Health care index score

KW - Outcome of TB-HIV patients

KW - TB-HIV co-infection

KW - TB-HIV health care utilisation

UR - http://www.scopus.com/inward/record.url?scp=84872313596&partnerID=8YFLogxK

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U2 - 10.5588/ijtld.12.0224

DO - 10.5588/ijtld.12.0224

M3 - Article

C2 - 23317955

AN - SCOPUS:84872313596

SN - 1027-3719

VL - 17

SP - 198-206+i

JO - International Journal of Tuberculosis and Lung Disease

JF - International Journal of Tuberculosis and Lung Disease

IS - 2

ER -

Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients

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