Incidence and predictors of mortality among persons with rifampicin-resistant tuberculosis and HIV in Mozambique

Rifampicin-Resistant Tuberculosis (RRTB) is associated with a high risk of mortality during treatment. This study aims to describe the baseline characteristics associated with incidence of mortality in persons with rifampicin-resistant tuberculosis (P-RRTB) in a rural setting in Mozambique. We analy...

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Autores: Nacarapa, Edy, Jose, Bendita, Munyangaju, Isabelle, Osório , Dulce, Ramos Rincón, José Manuel
Tipo de recurso: artículo
Fecha de publicación:2025
País:España
Institución:Universidad Miguel Hernández de Elche
Repositorio:REDIUMH. Depósito Digital de la UMH
OAI Identifier:oai:dspace.umh.es:11000/39470
Acceso en línea:https://hdl.handle.net/11000/39470
Access Level:acceso abierto
Palabra clave:RRTB
risk of mortality
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spelling Incidence and predictors of mortality among persons with rifampicin-resistant tuberculosis and HIV in MozambiqueNacarapa, EdyJose, BenditaMunyangaju, IsabelleOsório , DulceRamos Rincón, José ManuelRRTBrisk of mortalityRifampicin-Resistant Tuberculosis (RRTB) is associated with a high risk of mortality during treatment. This study aims to describe the baseline characteristics associated with incidence of mortality in persons with rifampicin-resistant tuberculosis (P-RRTB) in a rural setting in Mozambique. We analyzed cohort data collected retrospectively from paper medical files and electronic medical records of P-RRTB who were routinely treated at Carmelo Hospital of Chokwe (Gaza province, Mozambique), from 1st January 2015 to 31st December 2020. Kaplan-Meier survival curves and adjusted Cox regression analyses were used to model the time to death and associated factors of mortality. Overall, 151 P-RRTB contributed to a total number of 1812 person-months (PM) of treatment follow-up. The overall mortality rate was 1.9 per 100 person-months (95% confidence interval [CI]: 1.3-2.1). Adjusted Cox regression predicted higher risk of mortality in those treated with injectable anti-RRTB second line drugs (SLD), (adjusted hazard ratio [aHR] 3.72, 95% CI 1.23-11.22, p = 0.020), had a parenchymal lesion with more than 50% fibrosis (aHR 3.06, 95% CI 1.38-6.79, p = 0.006), presented right ventricular dysfunction on the echocardiogram with venous assessment (aHR 3.18, 95% CI 1.15-8.83, p = 0.026), and manifested baseline hemoglobin (Hgb) = 8.0-9.9 g/dL (aHR 2.82, 95% CI 1.09-7.27, p = 0.032), as well Hgb < 7.9 g/dL (aHR 3.06, 95%CI 1.24-7 0.51, p = 0.015). However, lower risk of mortality was predicted in those who had an optimal immunovirological response to ART (aHR 0.18, 95% CI 0.04-0.93, p = 0.040). Kaplan-Meier analysis showed higher cumulative incidence of mortality after 3 months of follow-up, above 26% in those with immunovirological failure to ART therapy (p = 0.006), 45% with Hgb < 7.9 g/dL (p < 0.001), 23% in treated with injectables-based drugs (p = 0.03), 39% with parenchymal lesion > 50% fibrosis on the chest X-ray (p < 0.001), 56% with right ventricular dysfunction (p = 0.003). Mortality risk among P-RRTB was higher in those with anemia, injectable anti-RRTB medications, lung lesions > 50% fibrosis, and right ventricular dysfunction.NatureDepartamentos de la UMH::Medicina Clínica202620262025info:eu-repo/semantics/articleapplication/pdf15application/pdfhttps://hdl.handle.net/11000/39470reponame:REDIUMH. Depósito Digital de la UMHinstname:Universidad Miguel Hernández de ElcheInglés10.1038/s41598-025-20658-7info:eu-repo/semantics/openAccessAttribution-NonCommercial-NoDerivatives 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/oai:dspace.umh.es:11000/394702026-05-27T13:36:21Z
dc.title.none.fl_str_mv Incidence and predictors of mortality among persons with rifampicin-resistant tuberculosis and HIV in Mozambique
title Incidence and predictors of mortality among persons with rifampicin-resistant tuberculosis and HIV in Mozambique
spellingShingle Incidence and predictors of mortality among persons with rifampicin-resistant tuberculosis and HIV in Mozambique
Nacarapa, Edy
RRTB
risk of mortality
title_short Incidence and predictors of mortality among persons with rifampicin-resistant tuberculosis and HIV in Mozambique
title_full Incidence and predictors of mortality among persons with rifampicin-resistant tuberculosis and HIV in Mozambique
title_fullStr Incidence and predictors of mortality among persons with rifampicin-resistant tuberculosis and HIV in Mozambique
title_full_unstemmed Incidence and predictors of mortality among persons with rifampicin-resistant tuberculosis and HIV in Mozambique
title_sort Incidence and predictors of mortality among persons with rifampicin-resistant tuberculosis and HIV in Mozambique
dc.creator.none.fl_str_mv Nacarapa, Edy
Jose, Bendita
Munyangaju, Isabelle
Osório , Dulce
Ramos Rincón, José Manuel
author Nacarapa, Edy
author_facet Nacarapa, Edy
Jose, Bendita
Munyangaju, Isabelle
Osório , Dulce
Ramos Rincón, José Manuel
author_role author
author2 Jose, Bendita
Munyangaju, Isabelle
Osório , Dulce
Ramos Rincón, José Manuel
author2_role author
author
author
author
dc.contributor.none.fl_str_mv Departamentos de la UMH::Medicina Clínica
dc.subject.none.fl_str_mv RRTB
risk of mortality
topic RRTB
risk of mortality
description Rifampicin-Resistant Tuberculosis (RRTB) is associated with a high risk of mortality during treatment. This study aims to describe the baseline characteristics associated with incidence of mortality in persons with rifampicin-resistant tuberculosis (P-RRTB) in a rural setting in Mozambique. We analyzed cohort data collected retrospectively from paper medical files and electronic medical records of P-RRTB who were routinely treated at Carmelo Hospital of Chokwe (Gaza province, Mozambique), from 1st January 2015 to 31st December 2020. Kaplan-Meier survival curves and adjusted Cox regression analyses were used to model the time to death and associated factors of mortality. Overall, 151 P-RRTB contributed to a total number of 1812 person-months (PM) of treatment follow-up. The overall mortality rate was 1.9 per 100 person-months (95% confidence interval [CI]: 1.3-2.1). Adjusted Cox regression predicted higher risk of mortality in those treated with injectable anti-RRTB second line drugs (SLD), (adjusted hazard ratio [aHR] 3.72, 95% CI 1.23-11.22, p = 0.020), had a parenchymal lesion with more than 50% fibrosis (aHR 3.06, 95% CI 1.38-6.79, p = 0.006), presented right ventricular dysfunction on the echocardiogram with venous assessment (aHR 3.18, 95% CI 1.15-8.83, p = 0.026), and manifested baseline hemoglobin (Hgb) = 8.0-9.9 g/dL (aHR 2.82, 95% CI 1.09-7.27, p = 0.032), as well Hgb < 7.9 g/dL (aHR 3.06, 95%CI 1.24-7 0.51, p = 0.015). However, lower risk of mortality was predicted in those who had an optimal immunovirological response to ART (aHR 0.18, 95% CI 0.04-0.93, p = 0.040). Kaplan-Meier analysis showed higher cumulative incidence of mortality after 3 months of follow-up, above 26% in those with immunovirological failure to ART therapy (p = 0.006), 45% with Hgb < 7.9 g/dL (p < 0.001), 23% in treated with injectables-based drugs (p = 0.03), 39% with parenchymal lesion > 50% fibrosis on the chest X-ray (p < 0.001), 56% with right ventricular dysfunction (p = 0.003). Mortality risk among P-RRTB was higher in those with anemia, injectable anti-RRTB medications, lung lesions > 50% fibrosis, and right ventricular dysfunction.
publishDate 2025
dc.date.none.fl_str_mv 2025
2026
2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/11000/39470
url https://hdl.handle.net/11000/39470
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv 10.1038/s41598-025-20658-7
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
Attribution-NonCommercial-NoDerivatives 4.0 Internacional
http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
rights_invalid_str_mv Attribution-NonCommercial-NoDerivatives 4.0 Internacional
http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.format.none.fl_str_mv application/pdf
15
application/pdf
dc.publisher.none.fl_str_mv Nature
publisher.none.fl_str_mv Nature
dc.source.none.fl_str_mv reponame:REDIUMH. Depósito Digital de la UMH
instname:Universidad Miguel Hernández de Elche
instname_str Universidad Miguel Hernández de Elche
reponame_str REDIUMH. Depósito Digital de la UMH
collection REDIUMH. Depósito Digital de la UMH
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812455

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