{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T02:04:57Z","timestamp":1747188297550,"version":"3.40.5"},"reference-count":61,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T00:00:00Z","timestamp":1702598400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Despite declining TB notifications in Southern Africa, TB\u2010related deaths remain high. We describe patient\u2010 and population\u2010level trends in TB\u2010related deaths in Eswatini over a period of 11\u2009years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patient\u2010level (retrospective cohort, from 2009 to 2019) and population\u2010level (ecological analysis, 2009\u20132017) predictors and rates of TB\u2010related deaths were analysed in HIV\u2010negative and HIV\u2010coinfected first\u2010line TB treatment cases and the population of the Shiselweni region. Patient\u2010level TB treatment data, and population and HIV prevalence estimates were combined to obtain stratified annual mortality rates. Multivariable Poisson regressions models were fitted to identify patient\u2010level and population\u2010level predictors of deaths.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 11,883 TB treatment cases, 1302 (11.0%) patients died during treatment: 210\/2798 (7.5%) HIV\u2010negative patients, 984\/8443 (11.7%) people living with HIV (PLHIV), and 108\/642 (16.8%) patients with unknown HIV\u2010status. The treatment case fatality ratio remained above 10% in most years. At patient\u2010level, fatality risk was higher in PLHIV (aRR 1.74, 1.51\u20132.02), and for older age and extra\u2010pulmonary TB irrespective of HIV\u2010status. For PLHIV, fatality risk was higher for TB retreatment cases (aRR 1.38, 1.18\u20131.61) and patients without antiretroviral therapy (aRR 1.70, 1.47\u20131.97). It decreases with increasing higher CD4 strata and the programmatic availability of TB\u2010LAM testing (aRR 0.65, 0.35\u20130.90). At population\u2010level, mortality rates decreased 6.4\u2010fold (\u2212147\/100,000 population) between 2009 (174\/100,000) and 2017 (27\/100,000), coinciding with a decline in TB treatment cases (2785 in 2009 to 497 in 2017). Although the absolute decline in mortality rates was most pronounced in PLHIV (\u2212826\/100,000 vs. HIV\u2010negative: \u221223\/100,000), the relative population\u2010level mortality risk remained higher in PLHIV (aRR 4.68, 3.25\u20136.72) compared to the HIV\u2010negative population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>TB\u2010related mortality rapidly decreased at population\u2010level and most pronounced in PLHIV. However, case fatality among TB treatment cases remained high. Further strategies to reduce active TB disease and introduce improved TB therapies are warranted.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13961","type":"journal-article","created":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T18:39:12Z","timestamp":1702665552000},"page":"192-205","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sustained high fatality during <scp>TB<\/scp> therapy amid rapid decline in <scp>TB<\/scp> mortality at population level: A retrospective cohort and ecological analysis from Shiselweni, Eswatini"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0525-7262","authenticated-orcid":false,"given":"Bernhard","family":"Kerschberger","sequence":"first","affiliation":[{"name":"M\u00e9decins sans Fronti\u00e8res  Mbabane Eswatini"},{"name":"M\u00e9decins sans Fronti\u00e8res\/\u00c4rzte ohne Grenzen Vienna Evaluation Unit  Vienna 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