Abstract
BackgroundLost to follow-up (LTFU) negatively affects the treatment success of Anti-Retroviral Therapy (ART) and thus, increases Tuberculosis-Human Immunodeficiency Virus (TB/HIV) related morbidity, mortality and hospitalization. However, the incidence and predictors of loss to follow up (LTFU) among adults with TB/HIV co-infection have not yet well-investigated in Ethiopia. Therefore, this study was aimed at investigating the incidence and predictors of LTFU in the study setting in particular.MethodsA facility based retrospective cohort study was employed among 305 (114 anemic and 191 normal) TB/HIV co-infected adults in two governmental hospitals (Mekelle Hospital and Ayder Comprehensive Specialized Hospital), Mekelle, Ethiopia from 2009 to 2016 and data were collected using checklist. Besides to descriptive statistics, a cox regression analysis was applied to identify statistically significant predictors of LTFU at 5% level of significance. Eventually, the Adjusted Hazard Ratio (AHR) and 95% Confidence Interval (CI) were estimated and interpreted for predictors of LTFU in the final cox model.ResultsGenerally, 45 of 305 (14.8%) of TB/HIV co-infected adults were LTFU with an incidence rate of 4.5 new LTFUs per 100 Person Years (PYs) and a median follow up time of 3.1 years (Interquartile Range (IQR): 0.8–5.3 Years). Hemoglobin level ≤ 11.0 g/dl (AHR = 2.660; 95%CI: 1.459–4.848), and any history of OI/s (AHR = 3.795; 95%CI: 1.165–12.364) were risk factors of LTFU. While, adverse drug events (AHR = 0.451; 95%CI: 0.216–0.941), TB treatment completion (AHR = 0.121; 95% CI: 0.057–0.254), and being on Isoniazid Preventive Therapy (IPT) (AHR = 0.085; 95%CI: 0.012–0.628) had protective effect against LTFU.ConclusionsOne in approximately seven TB/HIV co-infected adults had experienced of LTFU with an incidence rate 4.5 LTFUs per 100 PYs. The LTFU rate was higher among adults with low baseline hemoglobin level, no adverse drug events, presence of OI/s, failure to complete TB treatment, and being not on IPT. Therefore, it is advisable to treat anemia and active TB, and preventing the occurrence of OIs including TB using IPT to reduce the incidence of LTFU among TB/HIV co-infected adults.
Highlights
Lost to follow-up (LTFU) negatively affects the treatment success of Anti-Retroviral Therapy (ART) and increases Tuberculosis-Human Immunodeficiency Virus (TB/HIV) related morbidity, mortality and hospitalization
Regarding LTFU, 45 of 305 (14.8%) of adults co-infected with TB/HIV experienced LTFU throughout the entire follow up time and the overall LTFU rate was found to be approximately 4.5 LTFU cases per 100 Person Years (PYs) with a median follow up time of 3.1 years (Interquartile Range (IQR): 0.8–5.3 Years)
Majority (68.9%) of the total LTFUs were seen among adults who had an age above the median (> 35 years) and approximately 89.0% of the event of interest was observed among orthodox followers (Table 1)
Summary
Lost to follow-up (LTFU) negatively affects the treatment success of Anti-Retroviral Therapy (ART) and increases Tuberculosis-Human Immunodeficiency Virus (TB/HIV) related morbidity, mortality and hospitalization. The incidence and predictors of loss to follow up (LTFU) among adults with TB/HIV co-infection have not yet well-investigated in Ethiopia. From infectious diseases’ statistics, Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) are the leading causes of death globally. Despite many efforts have been made to control and prevent the dual occurrences of the diseases, yet TB is the leading cause of mortality and morbidity in People Living with HIV (PLHIV) [1]. The reactivation of Latent TB infection (LTBI) to active TB diseases is pronounced among PLHIV by approximately 20 times on average. Approximately one million PLHIV co-infected with TB in 2017. If diagnosis is delayed there is increased risk of mortality from multi-drug resistant and extensively drug-resistant TB [2]
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