Tuberculosis Deaths Among Populations with High HIV Prevalence
Death is the outcome of tuberculosis most feared by patients and their families. The development of antituberculosis chemotherapy in the 1950s led to dramatic reductions in tuberculosis deaths in populations with access to treatment. The emergence of HIV in the 1980s reinstated tuberculosis as "a captain of the men of death" in countries with high HIV prevalence. The annual global toll of deaths among tuberculosis patients is currently about 2 million. Along with reducing morbidity and disease transmission, reducing tuberculosis deaths is one of the objectives of tuberculosis control. The world faces the challenge of reducing tuberculosis deaths by half by 2015, as part of achieving the United Nations Millennium Development Goals. Since HIV increases the risk of death during and after tuberculosis treatment, and is related to the degree of immunosuppression, the total number of deaths among tuberculosis patients is increased in populations with high HIV prevalence. Sub-Saharan Africa is the region most badly affected by the HIV epidemic and therefore also with the highest proportion of tuberculosis deaths attributable to HIV. Improvements in the routine reporting of deaths by national tuberculosis programmes will increase the utility of tuberculosis deaths as an indicator of programme performance. Improved epidemiological surveillance of tuberculosis mortality depends on investment in developing vital registration systems. Decreasing deaths among tuberculosis patients in countries with high HIV prevalence depends on measures to decrease tuberculosis incidence (by implementing the World Health Organization expanded strategy to control HIVrelated tuberculosis) and to decrease tuberculosis case fatality (e.g. health service improvements to decrease diagnostic delay, antiretroviral treatment, co-trimoxazole).
Keywords: National Tuberculosis Programmes (NTPs), case fatality rate (CFR), pulmonary tuberculosis, Immunosuppression, HIV interventions
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