A systematic review of risk factors for mortality among tuberculosis patients in South Africa

Nicholson, Tamaryn J; Hoddinott, Graeme; Seddon, James A; Claassens, Mareli M; van der Zalm, Marieke M; Lopez, Elisa; Bock, Peter; Caldwell, Judy; Da Costa, Dawood; de Vaal, Celeste; Dunbar, Rory; Du Preez, Karen; Hesseling, Anneke C; Joseph, Kay; Kriel, Ebrahim; Loveday, Marian; Marx, Florian M; Meehan, Sue-Ann; Purchase, Susan; Naidoo, Kogieleum; Naidoo, Lenny; Solomon-Da Costa, Fadelah; Sloot, Rosa; Osman, Muhammad

doi:10.1186/s13643-023-02175-8

Systematic Reviews

Table 3 Tuberculosis case fatality ratios by specific population and reported subgroups, South Africa, 2010–2018

From: A systematic review of risk factors for mortality among tuberculosis patients in South Africa

Specific population	First author and year published	Total study population	Deaths	CFR	Subgroup	n	Deaths	CFR	Unknown outcome	CFR^g known outcomes
DS-TB, HIV+, children	Yotebieng 2010 [49]	573	37	6.5	Death before ART	112	7	6.3	38	9.5
DS-TB, HIV+, children					Death after ART	461	30	6.5	37	7.1
DST mixed or not specified, HIV+	Kerkhoff 2016 [42]	174	21	12.1	Hospitalised	116	12	10.3	8	11.1
DST mixed or not specified, HIV+					Ambulatory	58	9	15.5	1	15.8
DST mixed or not specified, HIV+	Griesel 2018 [40]	255	34	13.3
DS-TB, HIV+	Janssen 2017 [34]	60	16	26.7
DST mixed or not specified, HIV+	Abdool Karim 2010 [47]	642	52	8.1	Integrated ^a ART	429	25	5.8
DST mixed or not specified, HIV+					Sequential ^a ART	213	27	12.7
DS-TB	Churchyard 2011 [48]	1 302	104	8.0	Miners: 6-month screening ^b	670	44	6.6
DS-TB					Miners: 12-month screening ^b	632	60	9.5
DST mixed or not specified	Field 2014 [41]	4 162	509	12.2	HIV− or unknown	1 341	37	2.8
					HIV+ on ART	675	106	15.7
					HIV+ no ART	2 169	366	16.9
DST mixed or not specified, HIV+	Kendon 2012 [43]	458	55	12.0	Immediate ^c ART	303	47	15.5
					Early ^c ART	85	7	8.2
					Delayed ^c ART	70	1	1.4
DR-TB	Pietersen 2015 [29]	178	93	52.3	Capreomycin rrs A1401G mutation	154	78	50.6
DR-TB					Capreomycin rrs wild type	24	15	62.5
DR-TB	Kvasnovsky 2011 [28]	274	160	58.4	Treatment started	206	95	46.1
					HIV− started treatment ^d	87	31	35.6
					HIV+ started treatment ^d	108	55	50.9
DR-TB	Dheda 2010 [32]	199	83	41.7	Total cohort	199	83	41.7	4	42.6
					On XDR treatment	174	62	35.6
					HIV+ on XDR treatment	82	34	41.5
					HIV− on XDR treatment	92	28	30.4
DR-TB, HIV+	Umanah 2015 [35]	947	181	19.1	HIV+ with MDR	947	181	19.1	250	26.0
					HIV+ ART before TB treatment	545	119	21.8	131	28.7
					HIV+ ART after TB treatment	402	62	15.4	119	21.9
DR-TB	Olaleye 2016 [33]	442	151	34.2	Age 15–60	431	144	33.4
					Age 60–68	11	7	63.6
					Men	252	79	31.3
					Women	190	72	37.9
					Mpumalanga resident ^d	196	19	9.7
					Other province resident ^d	214	13	6.1
					Unmarried ^d	87	22	25.3
					Married ^d	57	31	54.4
					Previous treatment ^d	89	26	29.2
					No previous treatment ^d	345	123	35.7
					HIV−	43	13	30.2
					HIV (not tested)	227	70	30.8
					HIV+	172	68	39.5
					On ART ^d	136	53	39.0
					No ART ^d	22	7	31.8
					Smear – ^d	247	53	21.5
					Smear + ^d	183	90	49.2
DR-TB	Pietersen 2014 [17]	107	78	72.9	General	107	78	72.9	11	81.3
DR-TB	Brust 2018 [44]	206	24	11.7	HIV+	150	19 ^e	12.7	27 ^e	15.4
DR-TB					HIV−	56	3 ^e	5.4	9 ^e	6.4
DST mixed or not specified	Marais 2014 [36]	351	65	18.5	Total cohort	351	65	18.5	128	29.1
	Marais 2014 [36]	351	65	18.5	HIV− ^d	72	11	15.3	19	20.8
					HIV+ ^d	203	45	22.2	53	30.0
					HIV unknown ^d	49	9	18.4	29	45.0
DR-TB	Gandhi 2012 [18]	262	189	72.1	MDR patients	123	78	63.4
DR-TB					XDR patients	139	111	79.9
DR-TB	Loveday 2012 [45]	860	97	11.3	General	860	97	11.3	212	15.0
					Site–centralised hospital	441	30	6.8	133	9.7
					Site–decentralised	419	67	16.0	79	19.7
DR-TB	O'Donnell 2013 [31]	114	48	42.1	General	114	48	42.1	19	50.5
DR-TB	Brust 2010 [37]	1209	223	18.4	General	1209	223	18.4	252	23.3
					HIV+	362	90	24.9	81	32.0
					Previous TB	959	160	16.7
HIV+, TBM	Marais 2011 [30]	120	59	49.2	Total cohort	120	59	49.2	14	49.2
HIV+, TBM					HIV+	106	39	36.8
DST mixed or not specified, HIV+	Lawn 2017 [39]	139	19	13.7	u-LAM negative ^f	83	6	7.2
DST mixed or not specified, HIV+					u-LAM positive ^f	53	13	24.5
DST mixed or not specified, HIV+	Pepper 2011 [38]	100	15	15.0
DST mixed or not specified, children, TBM	Seddon 2012 [46]	123	11	8.9

ART antiretroviral therapy, CFR case fatality ratio, DR drug-resistant, DS drug-susceptible, INH isoniazid, IRR incident rate ratio, MDR multidrug-resistant, MR mono-resistant, NS non-specified, RIF rifampicin, TB tuberculosis, TBM tuberculosis meningitis, u-LAM urinary lipoarabinomannan, XDR extensively drug-resistant, + positive, − negative
^aThe timing of ART initiation defined relative to TB treatment as: Integrated: where ART started within 4 weeks of starting TB treatment, or within 4 weeks of completing the intensive phase of TB treatment; and Sequential: ART: where ART was started within 4 weeks of completion of TB treatment [47]
^bScreening: All miners were routinely screened for TB using a miniature screening chest radiograph (100 mm × 100 mm)
^cThe timing of ART initiation defined relative to TB treatment as: Immediate: TB patients who started ART ≤ 28 days after starting TB treatment; Early: TB patients who started ART 29–56 days after starting TB treatment; Delayed: TB patients who started ART ≥ 57 days after starting TB treatment [43]
^dFor these subgroups the unknown categories were not specified, and the sum of the subgroups does not equal to the study sample
^e2 patients who died after cure were not classified by HIV status and could not be reported in each subgroup; and 2 patients who moved had unknown outcomes which were not disaggregated by HIV status
^f3 patients did not have a u-LAM result
^gCase fatality ratio calculated using deaths as a proportion of TB patients with a known outcome

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