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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)|
|Copyright: ||Apr-2011 |
|Date Added: ||7-May-2012 |
|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.|
|Appears in:||Thesis - Public Health|
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