Abstract
IntroductionTuberculosis (TB) is currently causing more deaths than Human Immunodeficiency Virus (HIV) globally. Ghana as one of the 30 high burden TB/HIV countries has a high annual TB case-fatality rate of 10%. The study sought to assess the effect of HIV infection on TB treatment outcomes and assess the time to mortality after treatment onset.MethodsWe conducted a review of treatment files of TB patients who were treated from January 2013 to December 2015 in two urban hospitals in the Accra Metropolis. Modified Poisson regression analysis was used to measure the association between HIV infection and TB treatment outcomes. Kaplan-Meier survival estimates were used to plot survival curves.ResultsSeventy-seven percent (83/107) of HIV infected individuals had successful treatment, compared to 91.2% (382/419) treatment success among HIV non-infected individuals. The proportion of HIV-positive individuals who died was 21.5% (23/107) whilst that of HIV-negative individuals was 5.5% (23/419). Being HIV-positive increased the risk of adverse outcome relative to successful outcome by a factor of 2.89(95% CI 1.76-4.74). The total number of deaths recorded within the treatment period was 46; of which 29(63%) occurred within the first two months of TB treatment. The highest mortality rate observed was among HIV infected persons (38.6/1000 person months). Of the 107 TB/HIV co-infected patients, 4(3.7%) initiated ART during TB treatment.ConclusionThe uptake of ART in co-infected individuals in this study was very low. Measures should be put in place to improve ART coverage among persons with TB/HIV co-infection to help reduce mortality.
Highlights
Tuberculosis (TB) is currently causing more deaths than Human Immunodeficiency Virus (HIV) globally
The overall prevalence of HIV among the participants was 20.3% (107/526) and most (96%; 505/526) the patients were treated as new TB patients
The low uptake of Antiretroviral therapy (ART) in our study may have contributed to the high mortality among the HIV co-infected patients since several studies show that integrated therapy has significant survival benefit [21,22,23]
Summary
Tuberculosis (TB) is currently causing more deaths than Human Immunodeficiency Virus (HIV) globally. Measures should be put in place to improve ART coverage among persons with TB/HIV co-infection to help reduce mortality. There has been more than a two-fold increase in the number of people receiving ART since 2010 in the world's most affected regions Eastern and Southern Africa. This has made a huge contribution to the reduction in acquired immune deficiency syndrome (AIDS)-related deaths worldwide - from 1.4 million in 2010 to 940,000 in 2017 [6]. In 2015, about 75% of TB/HIV deaths worldwide occurred in Sub Saharan Africa, with case fatality rates varying from under 5% to over 20% among countries in the region [8]. Latest reports suggest that the WHO African Region has one of the fastest rates of reductions in mortality (4% per year, since 2013 to 2015); second to the WHO European Region with 5% per year in the same five years [7]
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