The Impact of Implementation Fidelity on Mortality Under a CD4-Stratified Timing Strategy for Antiretroviral Therapy in Patients With Tuberculosis

American Journal of Epidemiology
M R PatelA Van Rie

Abstract

Among patients with tuberculosis and human immunodeficiency virus type 1, CD4-stratified initiation of antiretroviral therapy (ART) is recommended, with earlier ART in those with low CD4 counts. However, the impact of implementation fidelity to this recommendation is unknown. We examined a prospective cohort study of 395 adult patients diagnosed with tuberculosis and human immunodeficiency virus between August 2007 and November 2009 in Kinshasa, Democratic Republic of the Congo. ART was to be initiated after 1 month of tuberculosis treatment at a CD4 count of <100 cells/mm(3) or World Health Organization stage 4 (other than extrapulmonary tuberculosis) and after 2 months of tuberculosis treatment at a CD4 count of 100-350 cells/mm(3). We used the parametric g-formula to estimate the impact of implementation fidelity on 6-month mortality. Observed implementation fidelity was low (46%); 54% of patients either experienced delays in ART initiation or did not initiate ART, which could be avoided under perfect implementation fidelity. The observed mortality risk was 12.0% (95% confidence interval (CI): 8.2, 15.7); under complete (counterfactual) implementation fidelity, the mortality risk was 7.8% (95% CI: 2.4, 12.3), corresponding t...Continue Reading

References

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Citations

Jul 27, 2015·International Journal of Epidemiology·Daniel WestreichEnrique F Schisterman
Jul 30, 2016·American Journal of Epidemiology·Jessie K EdwardsDaniel Westreich
Feb 25, 2017·Journal of Acquired Immune Deficiency Syndromes : JAIDS·James G CarlucciUNKNOWN International Epidemiology Databases to Evaluate AIDS (IeDEA) Network
Sep 10, 2015·Current Opinion in HIV and AIDS·Richard J LessellsPeter Godfrey-Faussett
May 1, 2021·International Journal of Environmental Research and Public Health·Louise SchinckusPeter Chang

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