Tuberculosis mortality in HIV-infected individuals: a cross-national systematic assessment
Bibliographic record
Abstract
Christopher Au-Yeung1, Steve Kanters1, Erin Ding1, Philippe Glaziou2, Aranka Anema1,3, Curtis L Cooper4, Julio SG Montaner1,3, Robert S Hogg1,5, Edward J Mills1,61BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; 2Stop TB Department, World Health Organization, Geneva, Switzerland; 3Faculty of Medicine, University of British Columbia, Vancouver, Canada; 4The Ottawa Hospital Division of Infectious Diseases; 5Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada; 6Faculty of Health Sciences, University of Ottawa, Ottawa, CanadaObjective: Tuberculosis (TB) is a leading cause of death in human immunodeficiency virus (HIV)-positive individuals. We sought to compare mortality rates in TB/HIV co-infected individuals globally and by country/territory.Design: We conducted a cross-national systematic assessment.Methods: TB mortality rates in HIV-positive and HIV-negative individuals were obtained from the World Health Organization (WHO) Stop TB department for 212 recognized countries/territories in the years 2006–2008. Multivariate linear regression determined the impact of health care resource and economic variables on our outcome variable, and TB mortality rates.Results: In 2008, an estimated 13 TB/HIV deaths occurred per 100,000 population globally with the African region having the highest death rate ([AFRH] ≥4% adult HIV-infection rate) at 86 per 100,000 individuals. The next highest rates were for the Eastern European Region (EEUR) and the Latin American Region (LAMR) at 4 and 3 respectively per 100,000 population. African countries’ HIV-positive TB mortality rates were 29.9 times higher than non-African countries (95% confidence interval [CI]: 16.8–53.4). Every US$100 of government per capita health expenditure was associated with a 33% (95% CI: 24%–42%) decrease in TB/HIV mortality rates. The multivariate model also accounted for calendar year and did not include highly active antiretroviral therapy (HAART) coverage.Conclusions: Our results indicate that while the AFRH has the highest TB/HIV death rates, countries in EEUR and LAMR also have elevated mortality rates. Increasing health expenditure directed towards universal HAART access may reduce mortality from both diseases.Keywords: tuberculosis, HIV, antiretroviral therapy, mortality
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.206 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".