Abstract
Introduction The convergence of TB and HIV dual epidemics is a major public health challenge in Ghana as well as many developing countries. Treatment outcome monitoring is a vital part of the surveillance needed to successfully eliminate TB. The impact of HIV status and demographic and treatment-related factors on adverse TB treatment outcome has not been studied in the Greater Accra Regional Hospital. This study determined factors associated with TB treatment outcome in patients with TB-HIV coinfection and TB-only infection in the hospital. Method A cross-sectional study was carried out in the Greater Accra Regional Hospital. We reviewed TB treatment cards of patients who received treatment for tuberculosis in the hospital from 2008 to 2016. Data on treatment outcome and sociodemographic and clinical characteristics were extracted on TB-only-infected and TB/HIV-coinfected patients. The chi-squared test and binary and multiple logistic regression models were used to assess factors associated with adverse treatment outcome. Results Out of the 758 patient records analyzed, 174 (22.9%) were TB-HIV-coinfected patients. Overall treatment success for all TB patients was 88.1% (668/758). About 11.9% (90/758) of the patients had an adverse treatment outcome, including treatment failure 0.9% (7/758), defaulting 0.9% (7/758), and death 10.0% (76/758). TB-HIV-coinfected patients' treatment success was 78.1% (136/174). TB-only patients' treatment success was 91.4% (532/582). Independent predictors of adverse treatment outcome were found to be as follows: being HIV positive (aOR: 3.85, 95% CI: 2.19-6.75; p < 0.01); aged 65 and above (aOR: 1.76, 95% CI: 1.44-1.54; p = 0.01); and previously failed TB treatment (aOR: 5.02, 95% CI: 2.09-28.87; p < 0.01). Conclusion Treatment outcome for TB-HIV-coinfected patients is below the WHO target. HIV status, age, and category of patient of the TB patients were associated with adverse treatment outcome. Strengthening the TB/HIV collaborative efforts by stakeholders is required for good treatment outcomes.
Highlights
The convergence of TB and Human Immunodeficiency Virus (HIV) dual epidemics is a major public health challenge in Ghana as well as many developing countries
This study reports on the prevalence of HIV and treatment outcome of TB patients who received treatment at a Directly Observed Therapy Short-course (DOTS) center in the Greater Accra Regional Hospital (GARH) from 2008 to 2016
A total of 761 TB patients were registered at the Greater Accra Regional Hospital from January 2008 to December 2016
Summary
Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) are diseases of global public health concern despite the existing prevention and control strategies [1]. The TB/HIV policy which was in line with the WHO recommendations consists of three linked sets of activities: effective implementation of the Stop TB Strategy for TB control, improved HIV prevention and care, and implementation of a TB and HIV coinfection clinic [2]. This policy was fully implemented in the Greater Accra Regional Hospital (GARH) in December 2007. This study reports on the prevalence of HIV and treatment outcome of TB patients who received treatment at a Directly Observed Therapy Short-course (DOTS) center in the GARH from 2008 to 2016. The GARH was one of the first health facilities in Ghana that integrated TB-HIV activities
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