Tuberculosis Incidence, Predictors and TB Free Survival Among HIV Infected Adults who Completed Isoniazid Preventive Therapy in Hawassa Comprehensive Specialized Hospital, Sidama Regional State, Hawassa Ethiopia, 2020
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Date
2020-10
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Addis Ababa University
Abstract
Background: Tuberculosis (TB) is the most frequent life threatening opportunistic disease and theleading cause of death in HIV-infected people. At the same time, antiretroviral therapy (ART) is the single most important way to reduce the incidence of TB in people living with the HIV infection.
However, people with HIV on ART remain highly vulnerable to TB. Taking a six month course of Isoniazide Preventive Therapy (IPT) is known to reduce the risk of TB in people with HIV andlatent TB by 32-64% for two to three years.
Objectives: The aim of the study was to assess the incidence, predictors and TB free survival among HIV/AIDS patients on ART who completed IPT in Hawassa Comprehensive Specialized Hospital.
Methods: Five years Health institution based retrospective cohort study design was Conducted using a checklist to gather data from 483 randomly selected Adult HIV patients charts. The data extraction tool was developed from the standardized ART entry and follow up form currently used by the ART clinics based on WHO model. Data was cleared and entered into Epi-data V-4.62 and exported to SPSS V-25 for further statistical analysis. Data was analyzed by bivariate and multivariable analysis using Cox regression proportional hazard model. Survival was calculated and compared with the Kaplan Meier and log rank test respectively.
Results: A total of 483 HIV positive adults were studied. The median follow up time was 54 months (IQR = 20–41.75). A total of 55 TB cases occurred in 1490 total PY of follow up. The overall TB incidence was 3.7/100 PYO (95%CI; 2.6–2.8). Factors associated with TB incidence include; being Female (AHR = 2.07, 95% CI; 0.78–5.26), WHO stage III and IV (AHR = 3.2, 95%
CI; 1.15–8.95) and IV (AHR = 4.5, 95% CI; 0.19–1.094), Hgb <11 mg/dl were 3 times more likelyto had TB than Hgb >11 mg/dl (AHR= 3.17; 95%CI, 0.15 to7.01). Bedridden at baseline were 3.28times at higher risk of developing TB (AHR 3.28; 95%CI, 0.134 to 8.06). Individuals who completed IPT were 94% less likely to develop TB (AHR 0.60; 95%CI, 0.018 to 0.203). Viral load
<1000copies/ml were 1.96 more likely to developed TB than >1000 copies/ml (AHR=1.96; 95%CI,0.04 to 2.20).
Conclusion: Completion of IPT significantly reduced TB incidence by 94.0% and IPT had significantly protected occurrence of active TB for five years among HIV infected patients.
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Keywords
Adults, HIV/AIDS, Incidence, Predictors, Survival, Tuberculosis, Hawassa, Ethiopia.