Abstract
Background. Few studies have evaluated the rate of tuberculosis (TB)/human immunodeficiency virus (HIV) coinfection and the determinants of its treatment outcomes in Africa. We aimed to determine the predictors of unsuccessful treatment outcomes in HIV-infected tuberculosis patients in Nigeria. Methods. A retrospective cohort study design was used to assess adult TB/HIV patients who registered for TB treatment in two health facilities in Ebonyi State, Southeast Nigeria, between January 2011 and December 2012. Predictors of unsuccessful treatment outcomes were determined using multivariable logistic regression analysis. Results. Of 1668 TB patients, 342 (20.5%) were HIV coinfected. Of these, 195 (57%) had smear-negative pulmonary TB and 11 (3.2%) had extrapulmonary TB. Overall, 225 (65.8%) patients achieved successful outcomes, while 117 (34.2%) had unsuccessful outcomes. The unsuccessful treatment outcomes were due to “default” (9.9%), “death” (19%), “treatment failure” (1.5%), and “transferring out” (3.8%). Independent determinants for unsuccessful outcomes were receiving care at a public facility and noninitiation of antiretroviral therapy. Conclusion. There is need for the reevaluation of the quality of public sector treatment services provided for TB/HIV patients as well as further expansion of TB/HIV collaborative activities in rural areas, and interventions to reduce mortality and default rates among TB/HIV patients are urgently needed in Nigeria.
Highlights
Tuberculosis (TB) is the commonest opportunistic infection and the most important cause of morbidity and mortality in human immunodeficiency virus- (HIV-) infected patients [1]
This was a retrospective cohort study of adult (≥15 years) HIV-infected TB patients treated in two hospitals between 1 January 2011 and 31 December 2012 in Ebonyi State, Nigeria
From 1 January 2011 to 31 December 2012, 1668 TB patients were registered for treatment in the two study health facilities
Summary
Tuberculosis (TB) is the commonest opportunistic infection and the most important cause of morbidity and mortality in human immunodeficiency virus- (HIV-) infected patients [1]. Nigeria ranks tenth among the 22 high TB burden countries with 97,853 patients notified in 2012 accounting for an estimated prevalence rate of 161 per 100,000 population [2, 3]. Nigeria has the second largest burden of HIV in Africa with about 3.1 million people (4.1% of the population) estimated to be living with HIV in 2010 and, with a national HIV coinfection rate of 23% among TB patients, HIV is believed to be driving this epidemic [3, 5]. Few studies have evaluated the rate of tuberculosis (TB)/human immunodeficiency virus (HIV) coinfection and the determinants of its treatment outcomes in Africa. We aimed to determine the predictors of unsuccessful treatment outcomes in HIV-infected tuberculosis patients in Nigeria. There is need for the reevaluation of the quality of public sector treatment services provided for TB/HIV patients as well as further expansion of TB/HIV collaborative activities in rural areas, and interventions to reduce mortality and default rates among TB/HIV patients are urgently needed in Nigeria
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