Prevalence and associated risk factors for tuberculosis among people living with HIV in Nepal.

Nilaramba Adhikari,Ratna Bahadur Bhattarai,Lok Raj Joshi,Bhim Singh Tinkari,Anil Thapa,Rajendra Basnet,Basant Joshi,Bidhubhusan Mahapatra

doi:10.1371/journal.pone.0262720

Abstract

BackgroundWorldwide tuberculosis (TB) takes more lives than any other infectious diseases. WHO estimates around 68,000 incident TB cases in Nepal. However, in 2018 only around 27,232 new TB cases were reported in the national system, resulting around 40,768 incident TB cases missing every year in Nepal. National Tuberculosis Control Center carried out this study in anti-retroviral therapy (ART) sites to estimate the prevalence of TB and identify the associated risk factors for TB among the people living with Human Immunodeficiency Virus (PLHIVs) in Nepal.MethodsIt was a cross-sectional institution-based study conducted between March and August 2018. Six ART sites with high caseloads of PLHIVs were selected. PLHIVs who were equal or above 18 years of age and were in ART program at the selected study sites were considered eligible for the study. Diagnosis of tuberculosis among PLHIVs who agreed to participate in the study was carried out as per the National Tuberculosis Management Guideline of National Tuberculosis Program of Nepal.ResultsAmong 403 PLHIVs, tuberculosis was diagnosed in 40 (9.9%) individuals. Median age of the participants was 36 (30–43) years. Prevalence of TB was significantly higher among male PLHIVs than female PLHIVs (13.6% Vs 5.8%; P = 0.02) and Dalit ethnic group compared to Brahmin/Chettri (22.0%Vs5.9%, P = 0.01). The risk of developing TB was found significant among those with HIV stage progressed to WHO stage 3 and 4 (OR = 4.85, P<0.001) and with the family history of TB (OR = 4.50, P = 0.002).ConclusionsPrevalence of TB among PLHIVs in Nepal was found 9.9%. Risk of developing TB was higher among PLHIVs who were male, Dalit, with HIV stage progressed to WHO stage 3 and 4 and with family history of TB. Hence, targeted interventions are needed to prevent the risk of developing TB among PLHIVs. Similarly, integrated, and comprehensive TB and HIV diagnosis and treatment services are needed for the management of TB/HIV co-infection in Nepal.

Highlights

Worldwide tuberculosis (TB) takes more lives than any other infectious diseases [1]
National Tuberculosis Control Center carried out this study in anti-retroviral therapy (ART) sites to estimate the prevalence of TB and identify the associated risk factors for TB among the people living with Human Immunodeficiency Virus (PLHIVs) in Nepal
Prevalence of TB was significantly higher among male PLHIVs than female PLHIVs (13.6% Vs 5.8%; P = 0.02) and Dalit ethnic group compared to Brahmin/Chettri (22.0%Vs5.9%, P = 0.01)

Summary

Introduction

Worldwide tuberculosis (TB) takes more lives than any other infectious diseases [1]. For achieving the global tuberculosis control, early and accurate diagnosis of drug sensitive and drug resistant TB is crucial. The scenario of many countries depicts that case detection relies on patients reporting symptoms to health care facility. In such condition of delays in case identification and management, there remains a higher probability of transmission and continuation of epidemic [2]. HIV coinfection is the prime risk factor for developing active TB in the high-burden settings This in turn increases the susceptibility to primary infection or reinfection and the risk of TB reactivation for patients with latent TB. National Tuberculosis Control Center carried out this study in anti-retroviral therapy (ART) sites to estimate the prevalence of TB and identify the associated risk factors for TB among the people living with Human Immunodeficiency Virus (PLHIVs) in Nepal

Methods

Results

Conclusion