Treatment outcome of TB/HIV positive and TB/HIV negative patients on directly observed treatment, short course (DOTS) in Sagamu, Nigeria

Abstract

The World Health Organisation marked 10 years of implementation of Directly Observed Treatment short course (DOTS). One key factor affecting the success of the DOTS strategy is the rising HIV prevalence among TB patients. The study was embarked upon to compare the treatment outcome of TB/HIV positive and TB/HIV negative patients in Sagamu, Nigeria. A prospective study of 353 smear positive TB patients aged 15 years and above who were registered for 8 months anti-tuberculosis (DOTS) therapy between January 2001 and December 2003 at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. Treatment outcome indicators of cure, default, transfer to another district and death were assessed in relation to the HIV status of the patients. There were 353 eligible patients of which 58 (16.4%) were HIV positive. The clinical symptoms and signs of TB were similar in both HIV positive and negative TB patients. The cure rate was 76.8%.patients. The cure rate was significantly lower in HIV infected compared with non-HIV infected TB patients (60.3% v 80.0%;p = 0.0001). However, among survivors it was not significant (71.4% v 82.5%; p = 0.07). Overall mortality was 5.1% which was significantly higher in HIV positive compared to HIV negative TB patients (15.5% v 3.1%; p = 0.00007). On the whole, 17% defaulted treatment and 1.1% failed treatment. These were however not significantly related to HIV status. The cure rate in this study is still lower than the recommended 85% target by the WHO. Mortality rate in TB/HIV positive patients was higher than in HIV negative patients. The option of a community based TB programme using volunteers or family members to supervise administration of anti-TB drugs so as to ensure adherence to TB treatment may be considered.