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Title: THE EFFECT OF HAART ON INCIDENCE OF TUBERCULOSIS AMONG HIV INFECTED PATIENTS IN HAWASSA UNIVERSITY REFERRAL HOSPITAL, SOUTH ETHIOPIA
Authors: TAREKEGN, SOLOMON
Advisors: ALEMAYEHU WORKU (PhD)
Keywords: HAART
TUBERCULOSIS
Copyright: Apr-2011
Date Added: 7-May-2012
Publisher: AAU
Abstract: Background Information: Studies of Antiretroviral Therapy program in Africa have shown high incidence rate of tuberculosis in both Antiretroviral Therapy receiving and Antiretroviral Therapy naïve Human Immunodeficiency Virus infected patients. Tuberculosis incidence and factors that contribute for development of tuberculosis in era of Antiretroviral Therapy were poorly described in Ethiopia. Objective: To examine the effect of HAART on incidence rate of tuberculosis and tuberculosis free survival among HIV-positive adults in HAART receiving and HAART naïve groups enrolled to ART clinic in Hawassa University Referral Hospital. Method: A retrospective cohort study design was used on 632 HIV-positive adults with age 15 years old and above enrolled to ART clinic in Hawassa University Referral Hospital over a three-year period. Incidence rate of tuberculosis and TB free survival was calculated and compared for Pre-HAART and HAART follow up HIV/AIDS patients. In this study, patients who followed on Pre-HAART are considered as unexposed and patients who receiving HAART considered as exposed, and was followed for three years from July 2006 to January 2011. Result: A total of 632 patients (316 in ART and 316 in ART cohort) followed for a median of 32.9(IQR=17.6-36.5) months in Pre-HAART and 35.4 (IQR=23.6-36.5) months in HAART cohort. TB incidence rate was 3.5 and 7.2 per 100 PYO in HAART and Pre-HAART cohort respectively. Over all chance of not developing TB was high in HAART cohort (Log rank=8.24, df=1, P=0.004). Being on HAART (AHR=0.182, 95%CI=0.078-0.424, P<0.001), being married (AHR=0.354 95%CI=0.191-0.655, P=0.001) and widowed (AHR=0.375, 95%CI=0.169-0.831, P=0.016) were factors related to decreased TB incidence. WHO stage 3 or 4 (AHR=1.999, 95%CI=1.025-3.896, P=0.042), being bedridden (AHR=4.689, 95%CI=1.715-12.819, P=0.003), and having hemoglobin level less than 10mg/dl (AHR=2.497, 95%CI=1.098-5.679, P=0.036) were factors associated with increased risk of TB at multivariate analysis. Conclusion: HAART decreased new cases of tuberculosis by 81.8% compared to HAART naïve patients and the probability of not developing TB was higher in HAART cohort than Pre- HAART. The finding is similar level with other developing and developed countries, but still gross TB incidence rate was high in both Pre-HAART and HAART cohort when compared with developed countries. More efforts have to be taken to reduce TB incidence as level of most developed countries have achieved many years ago.
URI: http://hdl.handle.net/123456789/2778
Appears in:Thesis - Public Health

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