Incidence and Factors Predicting Active TB Occourance among Patients Enrolled in Art, Zewditu Hospital, Addis Ababa, Retrospective Cohort Study.
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Date
2015-05
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Addis Abeba Universty
Abstract
Background: Tuberculosis is a major opportunistic infection among people living with
HIV (PLWH). Antiretroviral Therapy (ART) was introduced in National AIDS Control
Programme to reduce the morbidity and mortality among those affected with HIV/AIDS.
Even though ART reduces tuberculosis (TB) incidence, risk of TB remains high after ART
initiation. However determinants of active TB among HIV patients on ART are not well
described in resource limited settings like Ethiopia.
Objectives: To determine incidence and factors predicting active TB occurrence among
patients enrolled in ART, in Zewditu Hospital, Addis Ababa.
Methods: A five year institution based retrospective follow up study was conducted by
chart review. All adult PLWHs newly enrolled on ART at Zewiditu hospital from
September 11, 2009 to August 31, 2010, was identified from electronic data base and
register. And those who fulfilled the inclusion criteria were retrospectively followed for
different periods in five years until March, 2015. The pretested data collection tool was used
in order to extract information’s from patient chart. Incidence rate of tuberculosis was
calculated. Cox proportional hazard regression model was used to identify predictors.
Results: A total of 480 patients were followed and produced 1952.5 Person-Years (PY) of
observation, and 70 new TB cases observed during the follow up period. The overall
incidence density of TB was 3.59 per 100 PY. It was high (76.59/100PY) in the first year of
enrolment. The cumulative proportion of TB- free survivals was 90% and 80% at the end of
the first and fifth years, respectively. After adjustment for potential confounders the
presence of INH prophylaxis (AHR=0.49, 95%CI=0.26-0.94), baseline WHO clinical stage
III or IV (AHR =2.37, 95%CI = 1.41-3.96), CD4 count <100 cell/ul (AHR 7.48,CI=2.86-
19.5), CD4 count between 101-200 cell/ul (AHR 3.53, CI=1.33-9.34), Hgb level less than
10 mg/dl (AHR= 2.32, CI=1.13-4.78), being addicted (AHR = 1.78, CI=1.07-2.96) and
poor adherence (AHR=2.98, 95%CI 1.36-6.52) were predictors of time to TB occurrence in
multivariate analysis.
Conclusions: IPT associated in reducing TB incidence so IPT service should be
strengthening among PLWHIV. Intensified screening is highly recommended during
treatment follow up for those who have advanced disease condition (WHO clinical stage
III/IV, CD4 count below 200 and having hemoglobin level below10 mg/dl) and in the first
year of follow up. Strengthen ongoing adherence and positive living counseling also
recommended.
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Incidence and Factors Predicting Active TB Occourance