Predictors of tuberculosis treatment success among HIV-TB co-infected patients attending major tuberculosis treatment sites in Abeokuta, Ogun State, Nigeria.

Kayode Akanbi,Saheed Gidado,Peter Nsubuga,Abisola Oladimeji,Samuel Fayemiwo,Ikeoluwapo Ajayi

doi:10.11604/pamj.supp.2019.32.1.13272

Abstract

Introductiontuberculosis (TB) is the commonest opportunistic infection and cause of death in patients with Human Immunodeficiency Virus (HIV) in developing countries. World Health Organization (WHO) recommends 85% treatment success rate for all TB cases as an indicator of TB control. The study aimed at determining TB treatment success rate among TB-HIV co-infected patients and identifying predictors of successful treatment among patients in TB treatment sites in Abeokuta, Nigeria.Methodsit was a cross-sectional study among HIV-TB co-infected patients in the two major health facilities in Abeokuta, Nigeria. Socio-demographic characteristics with treatment history were obtained using a semi-structured questionnaire. Sputum samples were collected and tested for acid-fast bacilli (AFB) using a standard method according to national guideline for TB treatment to determine treatment success rate. Treatment success was defined as any HIV positive patient with a diagnosis of TB by acid-fast bacilli (AFB) smear positivity at diagnosis, who after 6 months of complete treatment becomes smear negative. Adjusted odds ratio was used to identify independent predictors of successful treatment outcome with confidence interval set at 95% and level of significance set at P < 0.05.Resultsa total of 109 HIV-TB co-infected patients were enrolled for this study. Fifty-nine (54.1%) were females, 106 (97.3%) were newly treated for TB. Eighty-five (78.0%) were treated in a private health facility. A total of 91 had successful treatment outcome with a treatment success rate (TSR) of 83.5%. Eleven (10.1%) died, 5 (4.6%) defaulted, 1 (0.9%) failed treatment, 1 (0.9%) was transferred out. Successful treatment was associated with being newly registered (i.e. receiving TB treatment under the DOTS program for the first time), receiving TB treatment for the first time (adjusted OR = 18, 95%CI: 1.5-482.3) and being treated at a private health facility (adjusted OR = 14.1, 95%CI 4.27-48.4).Conclusiontreatment success rate of TB among HIV-TB co-infected patients in this study slightly falls below the WHO target. Registration status and health facility type were predictors of treatment outcome among study patients. Patients and healthcare workers in public facilities were educated on HIV-TB co-infection management.

Highlights

Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis and primarily affects the lungs but can affect other parts of the body [1]
Among the 109 patients recruited for the study, 91 had a successful treatment outcome with a treatment success rate (TSR) of 83.5%, 11 (10.1%) died, 5(4.6%) defaulted, 1 (0.9%) was transferred out and 1 (0.9%) had treatment failure (Figure 1)
We found that receiving treatment in a private health facility was a predictor of having a successful TB treatment outcome

Summary

Introduction

Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis and primarily affects the lungs (pulmonary) but can affect other parts of the body (extra-pulmonary) [1]. The most populous country in Africa with an estimated population of over 170 million people has a high HIV-positive TB death rate of 44 per 100,000 in 2014 [4]. It is believed that achieving these targets will lead to a reduction in TB prevalence, incidence, transmission and drug resistance to TB Those who remain positive for active TB at 5 months after commencement of treatment (treatment failure) remain infectious for prolonged periods of time and this promotes further transmission of the disease in the community which leads to high rates of multidrug-resistant (MDR) TB especially in resource-limited settings [5, 6]. TB/HIV coinfected patients have multiple individual, disease specific and treatment related factors that can adversely affect their treatment outcomes. Due to the significant diagnostic and therapeutic challenges that TB and HIV infection pose, this study was aimed to determine the predictors of TB treatment outcome and to assess the treatment success rate of TB among HIV patients attending major treatment sites in Abeokuta, Ogun State

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Methods

Results

Discussion

Conclusion