Tuberculosis Transmission or Mortality Among Persons Living with HIV, USA, 2011-2016

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Individuals with HIV are at increased risk for tuberculosis (TB) disease due to recent transmission (RT) and mortality during TB treatment.
• Understanding factors associated with RT and mortality in TB/HIV patients is crucial for effective public health interventions.

Purpose of the Study:

• To examine patient characteristics associated with recent TB transmission (RT) and mortality among TB/HIV patients.
• To identify risk factors and protective measures for improving outcomes in this vulnerable population.

Main Methods:

• Utilized National TB Surveillance System data from 2011 to 2016.
• Employed multivariable adjusted odds ratios (aOR) with 99% confidence intervals (CI) to assess associations between patient characteristics and RT or mortality.
• Mortality analyses were restricted to 2011-2014 to ensure adequate outcome reporting time.

Main Results:

• Recent TB transmission (RT) occurred in 20% of TB/HIV patients, with higher likelihoods among those reporting homelessness, substance use, and among Black and Hispanic individuals.
• RT was less common in non-US-born individuals.
• Mortality during TB treatment was higher in TB/HIV patients (8.6%) compared to those without HIV (5.2%).
• Factors associated with increased mortality included age (≥65 years and 45-64 years) and co-existing medical risk factors for TB.
• Directly observed treatment (DOT) for TB demonstrated a protective effect against mortality.

Conclusions:

• Prioritize interventions for Black, Hispanic, and homeless or substance-using TB/HIV patients to reduce TB transmission.
• Directly observed treatment (DOT) improves adherence and reduces mortality.
• Additional strategies are needed to decrease mortality among older TB/HIV patients and those with other medical risk factors.