Excellent treatment outcomes in children treated for tuberculosis under routine operational conditions in Cape Town, South Africa

Abstract

Background Tuberculosis (TB) remains a leading cause of death in children globally. While recognised that HIV infection increases the risk of developing TB, our understanding of the impact of HIV on risk of mortality for children treated for TB is limited. We aimed to identify predictors of mortality in children treated for drug- susceptible TB. Methods A retrospective analysis of all children (<15 years) routinely treated between 2005 and 2012 for drug-susceptible TB in Cape Town was conducted using the programmatic electronic TB treatment database. Survival analysis using cox regression was used to estimate hazard ratios for death. Logistic regression was used to estimate the odds of unfavourable outcomes. Results Of 29,519 children treated for and notified with TB over the study period, <1% died during TB treatment and 89.5% were cured or completed treatment. The proportion of children with known HIV status increased from 13% in 2005 to 95% in 2012. Children under 2 years had an increased hazard of death (aHR: 3.13; 95%CI:1.78 5.52) and greater odds of unfavourable outcome (aOR: 1.44; 95%CI:1.24-1.66) compared to children 10-15 years. HIVpositive children had increased mortality compared to HIV-negative children (aHR: 6.85; 95%CI:4.60-10.19) and increased odds of unfavourable outcome (aOR: 2.01; 95%CI:1.81-2.23). Later year of TB treatment was a protective predictor for both mortality and unfavourable outcome