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Incidence and determinants of tuberculosis infection among adult patients with HIV attending HIV care in north-east Ethiopia: a retrospective cohort study.

ABSTRACT: OBJECTIVE:This study assessed the incidence of tuberculosis (TB) and its predictors among adults living with HIV/AIDS in government health facilities in north-east Ethiopia. SETTING:A 5-year retrospective cohort study was conducted from May to June 2015 on 451 adult HIV/AIDS-infected individuals who enrolled in the HIV care clinics of government health facilities in north-east Ethiopia. PARTICIPANTS:A total of 451 HIV-infected adults who newly enrolled in the adult HIV care clinic from 1 July 2010 with complete information were followed until May 2015. PRIMARY OUTCOME MEASURE:The primary outcome was the proportion of patients diagnosed with TB or the TB incidence rate. SECONDARY OUTCOME MEASURE:The incidence of TB was investigated in relation to years of follow-up. RESULTS:A total of 451 charts with complete information were followed for 1377.41 person-years (PY) of observation. The overall incidence density of TB was 8.6 per 100 PYof observation. Previous TB disease (adjusted HR (AHR) 3.65, 95%?CI 1.97 to 6.73), being bedridden (AHR 5.45, 95%?CI 1.16 to 25.49), being underweight (body mass index (BMI) <18.5?kg/m2) (AHR 2.53, 95?% CI 1.27 to 5.05), taking isoniazid preventive therapy (IPT) (AHR 0.14, 95%?CI 0.05 to 0.39), haemoglobin below 11?g/dL (AHR 2.31, 95%?CI 1.35 to 3.93), and being in WHO clinical stages III and IV (AHR 2.84, 95%?CI 1.11 to 7.27; AHR 3.07, 95%?CI 1.08 to 8.75, respectively) were significant for the incidence of TB. CONCLUSION:The incidence of TB among adults living with HIV/AIDS in the first 3?years of follow-up was higher compared with that of subsequent years. Previous TB disease, no IPT, low BMI and haemoglobin level, advanced WHO clinical stage, and bedridden condition were the determinants of the incidence of TB. Therefore, addressing the significant predictors and improving TB/HIV collaborative activities should be strengthened in the study setting.

SUBMITTER: Ahmed A

PROVIDER: S-EPMC5829770 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Incidence and determinants of tuberculosis infection among adult patients with HIV attending HIV care in north-east Ethiopia: a retrospective cohort study.

Ahmed Ausman A Mekonnen Desalew D Shiferaw Atsede M AM Belayneh Fanuel F Yenit Melaku K MK

BMJ open 20180206 2

<h4>Objective</h4>This study assessed the incidence of tuberculosis (TB) and its predictors among adults living with HIV/AIDS in government health facilities in north-east Ethiopia.<h4>Setting</h4>A 5-year retrospective cohort study was conducted from May to June 2015 on 451 adult HIV/AIDS-infected individuals who enrolled in the HIV care clinics of government health facilities in north-east Ethiopia.<h4>Participants</h4>A total of 451 HIV-infected adults who newly enrolled in the adult HIV care ...[more]

PMID: 29437750

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Project description:BackgroundCervical cancer and human immunodeficiency virus prevention are public health priorities in Ethiopia. Despite cervical cancer being preventable with the Human Papilloma Virus vaccine and cervical cancer screening, HIV-infected women still have a low rate of screening, and data are scarce in this country. Thus, this study aimed to assess the prevalence of cervical cancer screening service utilization and associated factors among HIV-positive women in Southern Tigray, Ethiopia, 2018.MethodsA facility-based cross-sectional study was performed from March 1st to May 15th, 2018. We recruited 465 HIV-positive women using a systematic random sampling method. Data were collected using a pre-tested structured interviewer-administered questionnaire. Descriptive statistics, followed by multivariable logistic regression analysis were performed. Crude odds ratios, adjusted odds ratios, and 95% confidence intervals (CIs) were reported.ResultsIn this study, only 8% of HIV-positive women were screened for cervical cancer. The most frequently cited barrier by participants to getting screened was feeling healthy 282 (65.9%). Multiparity {AOR = 4.12, 95% CI = (1.70, 9.95)}, provider recommendation to get screened {AOR = 3.20, 95%CI = (1.34, 7.65)}, having good knowledge {AOR = 4.33, 95%CI = (1.66-11.29)}, and high perceived susceptibility for cervical cancer {AOR = 3.10, 95% CI = (1.31-7.33)} were the factors significantly associated with cervical cancer screening service utilization.ConclusionsThe prevalence of cervical cancer screening service utilization was quite low. Provider's recommendation to get screened, multiparity, knowledge, and perceived susceptibility were factors strongly associated with the service utilization. There is a need of routine counseling of health care providers for all HIV-positive women to get screened. Women's lack of knowledge also needs to be addressed by informing every HIV-positive woman that they are more susceptible to cervical cancer, and that screening is critical to fighting against the disease.

Project description:BackgroundOpportunistic infections (OIs) are illnesses that attack people with weakened immune systems, such as HIV patients, more frequently and severely. The majority of opportunistic infections (OIs) are the leading causes of morbidity and mortality in HIV/AIDS patients, emerging at the end of the illness. The objective of this study was to assess the incidence and risk factors of opportunistic infections (OIs) in HIV-infected children receiving antiretroviral therapy in public hospitals in Northeast Ethiopia.MethodsA multicenter retrospective follow-up study was undertaken at public hospitals in northeast Ethiopia from September 1, 2010, to January 30, 2022. A total of 341 HIV-infected children on antiretroviral therapy were included in the study. Data was entered using Epi-Data Manager version 4.6.1, and it was analyzed using STATA version 16.1. The opportunistic infection free-survival time was estimated using the Kaplan-Meier survival curve. Bivariable and multivariable Cox proportional hazard models were used to investigate the determinants of opportunistic infections.ResultsThe overall incidence rate of opportunistic infections (OIs) was 6.0 (95% CI: 5.0-7.1) per 100 child-years of observation. This study's participants were observed for a minimum of 9 months and a maximum of 122 months, for a total of 21,629 months, or 1802.4 years. Children with WHO clinical stages III and IV (AHR: 1.77; 95% CI: 1.13, 2.77), non-users of Cotrimoxazole Preventive Therapy (CPT) (AHR: 2.10; 95% CI: 1.40, 3.08), and low hemoglobin levels (10 mg/dl) (AHR: 1.88; 95% CI: 1.25, 2.82) were identified as significant predictors of opportunistic infection.ConclusionIn this study, the incidence rate of opportunistic infections among HIV-infected children was found to be high when compared to other studies. Low hemoglobin levels (10 mg/dl), low CD4 counts or percentages, clinical stages III and IV, and non-users of CPT were all associated with higher rates of opportunistic infection.

Project description:BackgroundAlthough it is a preventable and treatable disease, tuberculosis remains a major medical and public health problem throughout the world. The control and elimination of tuberculosis is currently challenged by the development and spread of antituberculosis drug resistance. The resistance is often correlated to the absence of properly implemented control measures that lead to poor treatment outcomes. Therefore, the aim of the current study was to assess poor treatment outcomes and its determinants among tuberculosis patients in selected health facilities in East Wollega zone, Western Ethiopia.MethodA five-year retrospective cross-sectional study design was employed. Data were collected from patients' medical record from January to March 2017. Data were entered and analyzed using SPSS version 20. Descriptive statistics were used to generate and summarize frequencies. Univariate and multivariate logistic regression analysis were used to associate the potential determinants of poor treatment outcomes.ResultsFrom 995 patients with documented treatment outcomes, 58.9% were males with a mean age of 31.9±16.3 years and 58% lived in rural areas. Majorities of cases (95.7%) were newly treated ones. Nearly half of the cases had extrapulmonary tuberculosis and 6.8% were co-infected with HIV. Nearly three-quarter of patients had completed their treatment while 17.2%, 2.9%, 4.8%, 0.4% patients were cured, defaulted, died, and failed, respectively. The overall treatment success rate was 91.9%. Being treated in Anger Gute health center (adjusted odds ratio (AOR): 2.27; 95% confidence interval (CI): 1.18-4.38); male (AOR: 1.81; 95% CI: 1.06-3.10); lived in rural areas (AOR: 1.73; 95% CI: 1.02-2.91); previously treated (AOR: 2.72; 95% CI: 1.16-6.39) and unknown HIV status (AOR: 4.56; 95% CI: 1.98-10.50) were determinants of poor treatment outcomes.ConclusionThe current treatment success rate was exceeded the recommended target. However, special attention and strict follow up is required for tuberculosis patients with high risk of unsuccessful treatment outcomes including male, rural resident, previously treated and unknown in HIV status patients throughout their treatment periods.

Project description:BackgroundIt is a global challenge to enrol and retain paediatric patients in HIV/AIDS care. Attrition causes preventable transmission, stoppable morbidity and death, undesirable treatment outcomes, increased cost of care and drug resistance. Thus, this study intended to investigate the incidence and predictors of attrition among children receiving antiretroviral treatment (ART).MethodA retrospective follow-up study was conducted among children <15 years who had ART follow-up in Gedeo public hospitals. After collection, data were entered into Epi-data V.4.6, then exported to and analysed using STATA V.14. Data were described using the Kaplan-Meier statistics, life table and general descriptive statistics. The analysis was computed using the Cox proportional hazard regression model. Covariates having <0.25 p values in the univariate analysis (such as developmental stage, nutritional status, haemoglobin level, adherence, etc) were fitted to multivariable analysis. Finally, statistical significance was declared at a p value of <0.05.ResultsAn overall 254 child charts were analysed. At the end of follow-up, attrition from ART care was 36.2% (92 of 254), of which 70 (76.1%) were lost to follow-up, and 22 (23.9%) children died. About 8145.33 child-months of observations were recorded with an incidence attrition rate of 11.3 per 1000 child-months (95% CI: 9.2 to 13.9), whereas the median survival time was 68.73 months. Decreased haemoglobin level (<10 g/dl) (adjusted HR (AHR)=3.1; 95% CI: 1.4 to 6.9), delayed developmental milestones (AHR=3.6; 95% CI: 1.2 to 10.7), underweight at baseline (AHR=5.9; 95% CI: 1.6 to 21.7), baseline CD4 count ≤200 (AHR=4.4; 95% CI: 1.6 to 12.2), and poor or fair ART adherence (AHR=3.5; 95% CI: 1.5 to 7.9) were significantly associated with attrition.Conclusion and recommendationRetention to ART care is challenging in the paediatrics population, with such a high attrition rate. Immune suppression, anaemia, underweight, delayed developmental milestones and ART non-adherence were independent predictors of attrition to ART care. Hence, it is crucial to detect and control the identified predictors promptly. Serious adherence support and strengthened nutritional provision with monitoring strategies are also essential.

Project description:BackgroundHuman immunodeficiency virus (HIV) affects a highly significant number of people and is responsible for the deaths of many people in sub-Saharan African countries alone. The best prevention method for this virus is through consistent condom utilization which can help to prevent drug-resistant HIV infection and acquisition of new infection. Therefore, this study aimed to assess consistent condom utilization and associated factors among HIV-positive individuals attending an antiretroviral therapy clinic at Pawi general hospital, North West Ethiopia in 2020.MethodsAn institutional based cross-sectional study was conducted among 419 HIV-positive individuals who have follow-up in the Pawi general hospital antiretroviral therapy clinics, from January to February 2020. The study subjects were reached using a systematic sampling technique and data were collected using a pretested and structured questionnaire. Data entry and analysis were performed using epi-data version 3.1 and SPSS version 23 respectively. Binary and multivariable analyses with a 95% confidence level were performed. In the final model, variables with P < 0.05 were considered statistically significant.ResultsA total of 419 antiretroviral therapy study participants were participated in the study with a response rate of 100%. In this finding, the consistent condom utilization rate was 49.2% [95% CI: 42.2-56.5%]. After controlling for possible confounding factors, the results showed that place of residence [AOR = 2.16, 95% CI: 1.05, 4.45], marital status [AOR = 0.19, 95%CI: 0.05, 0.67], number of partners [AOR = 0.19, 95% CI: 0.07, 0.55] and level of education [AOR = 5.33, 95% CI: 1.57, 18.08] were associated factors of consistent condom utilization.ConclusionConsistent condom utilization among HIV-positive clients attending antiretroviral therapy clinics at Pawi general hospital was low. Residence, marital status, level of education and number of partners were significantly associated factors of consistent condom use. Health education program and counseling services should be started to increase knowledge about way of transmission and appropriate use of condoms, increase self-efficacy towards condom use and reduction in the number of sexual partners.

Dataset Information

Incidence and determinants of tuberculosis infection among adult patients with HIV attending HIV care in north-east Ethiopia: a retrospective cohort study.

Publications

Incidence and determinants of tuberculosis infection among adult patients with HIV attending HIV care in north-east Ethiopia: a retrospective cohort study.

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