Abstract
BackgroundIn resource limited settings, Tuberculosis (TB) is a major cause of morbidity and mortality among patients on antiretroviral treatment. Ethiopia is one of the 30 high TB burden countries. TB causes burden in healthcare system and challenge the effectiveness of HIV care. This study was to assess incidence and predictors of Tuberculosis among adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia, 2019.MethodsInstitution based retrospective follow up study was conducted among adults on ART newly enrolled from 2014 to 2018 at Debre Markos Referral Hospital. Simple random sampling technique was used to select patients chart. Data was entered to EPI- INFO version 7.2.2.6 and analyzed using Stata 14.0. Tuberculosis incidence rate was computed and described using frequency tables. Both bivariable and multivariable Cox proportional hazard models was fitted to identify predictors of TB.ResultsOut of the 536 patients chart reviewed, 494 patient records were included in the analysis. A total of 62 patients developed new TB cases during the follow up period of 1000.22 Person Years (PY); which gives an overall incidence rate of 6.19 cases per 100 PY (95% CI: 4.83–7.95). The highest rate was seen within the first year of follow up. After adjustment base line Hemoglobin < 10 g/dl (AHR = 5.25; 95% CI: 2.52–10.95), ambulatory/bedridden patients at enrolment (AHR = 2.31; 95% CI: 1.13–4.73), having fair or poor ART adherence (AHR = 3.22; 95% CI: 1.64–6.31) were associated with increased risk of tuberculosis whereas taking Isoniazid Preventive Therapy (IPT) (AHR = 0.33; 95% CI: 0.12–0.85) were protective factors of TB occurrence.ConclusionTB incidence was high among adults on ART especially in the first year of enrollment to ART. Low hemoglobin level, ambulatory or bedridden functional status, non-adherence to ART and IPT usage status were found to be independent predictors. Hence, continuous follow up for ART adherence and provision of IPT has a great importance to reduce the risk of TB.
Highlights
In resource limited settings, Tuberculosis (TB) is a major cause of morbidity and mortality among patients on antiretroviral treatment
Due to the immunological impairment associated to Human Immunodeficiency Virus (HIV) infection, people living with human immunodeficiency virus (PLHIV) are at higher risk of developing TB [6]
This study showed that patients whose baseline hemoglobin level less than 10 g/dl were 5.25 times (AHR = 5.25; 95% Confidence Interval (CI): 2.52–10.95) at higher risk of developing TB at any time as compared to patients with hemoglobin level of greater than or equal to 10 g/dl
Summary
Tuberculosis (TB) is a major cause of morbidity and mortality among patients on antiretroviral treatment. Tuberculosis (TB) is the most frequently diagnosed opportunistic infection among people living with human immunodeficiency virus (PLHIV). It remains one of the world’s leading causes of ill health and death among PLHIV [1,2,3,4,5]. According to the 2017 global report, the risk of developing TB was 20 times higher in people living with HIV than in those without HIV [3, 7]. From 2018 United Nations Program on HIV/AIDS (UNAIDS) global report, in 2017 there were 36.9 million people living with HIV. TB accounts for around one in three AIDS related deaths [1] and from all TB/HIV related death about 84% is accounted in Africa [7]
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