Determinant Factors for the Occurrence of Tuberculosis among People Living With HIV After Art Initiation in Addis Ababa, Ethiopia: a Case Control Study

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Addis Abeba


Introduction: Tuberculosis is the leading killer of people with HIV/AIDS and the first presenting sign in the majority of AIDS patients. The risk of developing tuberculosis is estimated to be between 20- 37 times greater in people living with HIV than among those without HIV infection in their life time. In the developing world, many patients either have a history of tuberculosis when they initiate antiretroviral therapy, or they develop TB while receiving ART. ART diminishes the risk for TB as the CD4 count rises, yet the excess risk for TB is never eliminated even if CD4 levels return to normal levels. Objective: To assess determinant factors for the occurrence of TB among PLWHIV after ART initiation in public hospitals and health centers in Addis Ababa. Methodology: A case control study was conducted from December 2011 to February 2012 in selected 2 public hospitals and 13 health centers in Addis Ababa. The sample size of the study was 613 (204 cases and 409 controls). Cases were adult people living with HIV who developed TB after ART initiation and on anti TB treatment in the last 6 months prior to data collection and Controls were adult people living with HIV who did not develop TB after ART initiation. An interviewer administered structured questionnaire was used to collect information. Bivariate and multivariate analysis was performed by using logistic regression to determine independent factors of TB among PLWHIV after ART initiation. Result: After adjustment for potential confounders, having separate kitchen (AOR=0.50; 95% CI: 0.26, 0.96), the presence of INH prophylaxis (AOR=0.35; 95% CI: 0.125, 0.69) and cotrimoxazole prophylaxis (AOR=0.19; 95%CI: 0.06, 0.62) had an independent protective benefit against risk of tuberculosis. In contrary being bedridden (AOR= 9.36; 95%CI: 3.39, 25.85), having WHO clinical stage III or IV (AOR= 3.40; 95% CI: 1.69, 6.87), having opportunistic infection at ART initiation (AOR=5.22; 95%CI: 2.67, 10.27), the ART regimen initiated at base line and hemoglobin level less than 10mg/dl (AOR=0.35 ;95% CI: 0.125, 0.69) were an independent predictors for increased risk of tuberculosis in people living with HIV after ART initiation. Conclusion: Increasing coverage of INH preventive therapy and cotrimoxazole preventive therapy reduced the overall risk of TB among HIV patients who initatiated treatment. Targeting special attention is need to be provided for patients who have advanced condition(WHO clinical stage III or IV disease, being bedridden and having hemoglobin level less than 10mg/dl) would also reduce the risk of development of new TB infection. Improving housing condition and living standard is also recommended.



Determinant Factors for the Occurrence of Tuberculosis