Incidence and Factors Predicting Active TB Occourance among Patients Enrolled in Art, Zewditu Hospital, Addis Ababa, Retrospective Cohort Study.

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Addis Abeba Universty


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.



Incidence and Factors Predicting Active TB Occourance