Evidence map›Paper›PMID 40166654›Full record

ArticleEClinicalMedicine2025

High mortality among patients with tuberculosis accessing primary care facilities: secondary analysis from an open-label cluster-randomised trial.

Kogieleum Naidoo, Nonhlanhla Yende Zuma, Mikaila Moodley, Felix Made, Rubeshan Perumal, Santhanalakshmi Gengiah, Jacqueline Ngozo, Nesri Padayatchi, Andrew Nunn, Salim Abdool Karim

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in EClinicalMedicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02654613 (Addressing Challenges in Scaling up TB and HIV Treatment Integration in Public Health Settings in South Africa), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02654613 nacompletednot on this map

Addressing Challenges in Scaling up TB and HIV Treatment Integration in Public Health Settings in South Africa

TypeinterventionalSponsorCentre for the AIDS Programme of Research in South AfricaRan2015 to 2020Enrolled8,000ConditionsHIV, TuberculosisArmsQuality Improvement Model of Care
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Kogieleum NaidooCentre for the AIDS Programme of Research in South Africa (CAPRISA), South African Medical Research Council (SAMRC)-CAPRISA-TB-HIV Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa.
Nonhlanhla Yende ZumaCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
Mikaila MoodleyCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
Felix MadeCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
Rubeshan PerumalCentre for the AIDS Programme of Research in South Africa (CAPRISA), South African Medical Research Council (SAMRC)-CAPRISA-TB-HIV Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa.
Santhanalakshmi GengiahCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
Jacqueline NgozoDepartment of Health, KwaZulu- Natal Provincial HIV, AIDS, TB, and STI Directorate, South Africa.
Nesri PadayatchiCentre for the AIDS Programme of Research in South Africa (CAPRISA), South African Medical Research Council (SAMRC)-CAPRISA-TB-HIV Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa.
Andrew NunnMedical Research Council Clinical Trials Unit at University College London, London, UK.
Salim Abdool KarimCentre for the AIDS Programme of Research in South Africa (CAPRISA), South African Medical Research Council (SAMRC)-CAPRISA-TB-HIV Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Tuberculosis (TB) mortality remains persistently high, despite global TB control efforts. The aim of this study was to assess if a quality improvement (QI) intervention reduced deaths in TB patients accessing primary healthcare (PHC) services. Methods: In this pre specified secondary analysis of a cluster-randomized controlled study conducted in 2016-2018 in South Africa (Clinicaltrials.gov, NCT02654613), we compared 18-month case-fatality rates among newly diagnosed TB patients irrespective of HIV status randomized to clinics receiving the QI intervention and standard of care (SOC) [(eight clusters and 20 clinics per arm)]. Statistical inferences used a Findings: Among the 5817 newly diagnosed TB patients enrolled (intervention = 3473; control = 2344), 562 died by 18-months [case-fatality rate (CFR) = 9·7%]. Ninety percent of the deaths (506/562) occurred within six months of TB treatment initiation. Quality improvement intervention arm clinics compared to control arm clinics did not demonstrate a significant difference in TB CFR. Case-fatality rates were 9·5% [95% Confidence Interval (CI): 6·9-12·9] and 11·3% (95% CI: 8·7-14·7) [adjusted rate ratio (aRR), 0·9 (95% CI: 0·6-1·2)] in the intervention and control arms, respectively. In people living with HIV/AIDS (PLWHA) CFR in the intervention and control arms: were 10·8% (95% CI: 7·8-14·7) and 14·4% (95% CI: 9·3-22·4) in those on antiretroviral therapy (ART) and 18·6 (95% CI: 9·1-38·0) and 33·0 (95% CI: 16·2-67·3), in those with no ART data respectively. In the intervention and control arms CFR in HIV-TB coinfected patients was 6·5 (95% CI: 3·6-11·6) and 11·5 (95% CI: 6·5-20·0) in those on ART with viral loads <200 copies/ml and 22·4 (95% CI: 16·7-30·2) and 19·7 (95% CI: 11·3-34·5) in those with no viral load data as they commenced ART within 12 months before initiating TB treatment, respectively. Interpretation: The quality improvement intervention did not significantly reduce mortality. Funding: Research reported in this publication was supported by South African Medical Research Council (SAMRC), and UK Government's Newton Fund through United Kingdom Medical Research Council (UKMRC).

Indexed as

HIV-TB coinfected mortalityMortalityPrimary healthcareQuality improvementTB case fatality rate

Identifiers

PMID40166654
PMCPMC11957806

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.