Incidence and Predictors of Tuberculosis among HIV Infected Adults on Anti-Retroviral Therapy after Universal Test and Treat Program in Selected Public Hospitals -- Addis Ababa, Ethiopia, 2020

  • Vaccine preventable diseases
  • Viral hepatitis and HIV
  • Public health surveillance
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Background:
Tuberculosis (TB) is the leading cause of morbidity and mortality among people living with human immunodeficiency virus (HIV). Almost one-third of deaths among people living with HIV are attributed to TB. This study aimed to assess the incidence and predictors of TB among patients enrolled at public health hospitals of Addis Ababa, Ethiopia.

Methods:
An institutional-based retrospective follow up study was conducted at selected public health hospitals in Addis Ababa from January 1, 2016 to August 25, 2020. Multistage random sampling was employed to select a total of 539 adults enrolled on anti-retroviral therapy (ART). Data were collected by record review, entered into Epi Data version 3.1 and exported to STATA version 14.1 for analysis. A multivariable Cox-proportional hazard model was fit to identify predictors of TB among HIV patients and Adjusted Hazard Ratio (AHR) with the corresponding 95% Confidence Interval (CI) was reported to declare the significant predictors.

Results:
A total of 529 records were included in the final analysis and produced 1,529 Person-Years (PY) observation. The incidence rate of tuberculosis was 4.8 per 100 PY (95%CI, 3.8-6.1). Baseline WHO stages three or four (AHR:2.3, 95% CI:1.1-5.0), not taking isoniazid preventive therapy (IPT) (AHR: 2.8,95% CI: 1.1-7.3), CD4 count<200 (AHR: 3.1,95% CI:1.6,7.1), poor ART adherence (AHR:2.2, 95% CI:1.2-3.9), underweight with body-mass index [BMI] <18.5) (AHR:2.4, 95% CI: 1.30,4.51) and being bedridden (AHR:3.1, 95% CI: 1.5, 6.2) were independent predictors of TB.

Conclusions:
TB incidence declined following initiation of the test and treat program in Ethiopia in 2017. Poor adherence, BMI<18.5kg/m, not taking IPT, baseline WHO stage 3 or 4, bedridden functional status, low CD4 count increased the hazard of TB. Hence, close follow-up, reminders, surveillance, and tracing mechanisms targeting these high-risk groups would decrease TB among HIV patients.

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