1
|
Kegne TW, Anteneh ZA, Bayeh TL, Shiferaw BM, Tamiru DH. Survival Rate and Predictors of Mortality Among TB-HIV Co-Infected Patients During Tuberculosis Treatment at Public Health Facilities in Bahir Dar City, Northwest Ethiopia. Infect Drug Resist 2024; 17:1385-1395. [PMID: 38618582 PMCID: PMC11015844 DOI: 10.2147/idr.s446020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/03/2024] [Indexed: 04/16/2024] Open
Abstract
Background Tuberculosis and human immunodeficiency virus co-infection pose a major public health concern, particularly in developing countries. The survival and predictors of mortality were not sufficiently studied among TB-HIV co-infected patients in Ethiopia. Objective This study aimed to investigate the survival rate and predictors of mortality among TB-HIV co-infected patients during TB treatment at public health facilities in Bahir Dar, Northwest Ethiopia. Methods A retrospective follow-up study was conducted among 401 TB-HIV co-infected patients who were treated for tuberculosis between July 2018 and June 2022 at public health facilities in Bahir Dar city, Ethiopia. Data were collected using a structured checklist from patient charts. Data entry and analysis were done using EpiData 3.1 and Stata version 15, respectively. A Cox proportional Hazard regression model was used to identify predictors of mortality. Predictors with P < 0.05 in the multivariable regression were considered statistically significant. Results Among the 401 TB-HIV co-infected patients, 59 (14.7%) died during the follow-up period. Predictors like lower BMI (AHR = 3.00, 95% CI = 1.44, 6.28), extrapulmonary TB infection (AHR = 3.30, 95% CI = 1.50, 7.29), presence of opportunistic infection (AHR = 5.07, 95% CI = 2.55, 10.08), functional status (bedridden: AHR = 4.49, 95% CI = 1.63, 12.33), and adherence to TB treatment (fair = AHR = 2.74, 95% CI = 1.41, 7.20, and poor = AHR = 3.75, 95% CI = 1.52, 9.23) were associated with mortality. Conclusion Mortality among TB and HIV coinfected people was high at public health facilities in Bahir Dar city. This result suggested that in order to increase patient survival, it would be necessary to enhance nutritional status, increase adherence to TB treatment, and prevent opportunistic infections.
Collapse
Affiliation(s)
- Teshager Worku Kegne
- Department of Health Services, Management Sciences for Health, Addis Ababa, Ethiopia
| | - Zelalem Alamrew Anteneh
- Department of Epidemiology and Biostatistics, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadios Lidetu Bayeh
- Department of Epidemiology and Biostatistics, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Desiyalew Habtamu Tamiru
- Department of Public Health Emergency, Humedica e.V International Aid Organization, Addis Ababa, Ethiopia
| |
Collapse
|
2
|
Obeagu EI, Obeagu GU, Ubosi NI, Uzoma IC, Tayrab EMA. Concurrent management of HIV and malaria: A comprehensive review of strategies to enhance quality of life. Medicine (Baltimore) 2024; 103:e37649. [PMID: 38579091 PMCID: PMC10994515 DOI: 10.1097/md.0000000000037649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/27/2024] [Indexed: 04/07/2024] Open
Abstract
The co-occurrence of human immunodeficiency virus and malaria presents a complex medical scenario, significantly impacting the quality of life for affected individuals. This comprehensive review synthesizes current knowledge, challenges, and strategies concerning the concurrent management of these infections to improve overall well-being. Epidemiological insights reveal the prevalence and demographic trends, highlighting geographical areas of concern and socioeconomic factors contributing to the burden of co-infection. Pathophysiological interactions elucidate the compounding effects, altering disease progression and treatment outcomes. Healthcare challenges underscore the necessity for integrated care models, evaluating existing healthcare frameworks and their efficacy in addressing dual infections. In-depth analysis of interventions explores pharmacological, behavioral, and preventive measures, evaluating their efficacy and safety in co-infected individuals. Additionally, the review assesses psychosocial support mechanisms, emphasizing community-based interventions and peer networks in enhancing holistic care. Consideration is given to the role of antiretroviral therapy, malaria prevention strategies, and the evolving landscape of healthcare delivery in optimizing outcomes for this vulnerable population. The paper concludes by emphasizing the significance of multidisciplinary approaches and integrated care models, stressing the need for continued research and collaborative efforts to advance interventions and improve the quality of life for those navigating the complexities of human immunodeficiency virus and malaria co-infection.
Collapse
Affiliation(s)
| | | | - Nwanganga Ihuoma Ubosi
- Department of Medical Laboratory Science, Kampala International University, Kampala, Uganda
- Department of Public Health Sciences, Faculty of Health Sciences, National Open University of Nigeria, Jabi, Abuja, Nigeria
| | - Ijeoma Chinwe Uzoma
- Molecular-Hematology and Immuno Genetics Unit, Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Eltayeb Mohamed Ahmed Tayrab
- Chemical Pathology, Department of Pathology, Faculty of Medicine and Dentistry, Kampala International University, Kampala, Uganda
| |
Collapse
|
3
|
Banda L, Oladimeji O. A Scoping Review Protocol of Social Determinants of HIV/TB Coinfections in Sub-Saharan Africa. Methods Protoc 2024; 7:4. [PMID: 38251197 PMCID: PMC10801473 DOI: 10.3390/mps7010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction: Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) remain major public health issues in sub-Saharan Africa. The co-occurrence of these diseases is a growing concern in the region, and social determinants, the circumstances under which people are born, live, work, and age, are known to influence the risk of disease transmission, diagnosis, treatment, and outcomes. Here, we present a protocol for the evidence synthesis on the social determinants of HIV/TB coinfections in sub-Saharan Africa. The high prevalence of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) in sub-Saharan Africa presents significant public health challenges. TB/HIV comorbidity is influenced by various social determinants, including social, economic, cultural, and environmental factors, impacting disease transmission risk, accurate diagnosis, and treatment outcomes. This study protocol aims to provide an evidence synthesis on the social determinants of HIV/TB coinfection in sub-Saharan Africa. Methods and analysis: The researchers will use the Arksey and O'Malley's (2005) methodological framework to guide the scoping review. First, databases such as PubMed, MEDLINE, Web of Science, and PsychInfo will be searched. The researchers will then proceed in two steps. Before finalising the study selection, two independent reviewers will examine the article titles and abstracts for eligibility and inclusion. The researchers will then conduct a full-text screening of the articles based on the selected titles and abstracts. The authors' tool will be used to extract data, ensuring that the articles are properly screened and that the risk of bias is minimized. The chosen studies will be examined using a standardized tool to examine all bibliographic data and study characteristics. Ethics and dissemination: The review will provide an overview of the social determinants influencing the prevalence and outcomes of TB/HIV comorbidity in the region, as well as identify any research gaps. Policymakers, researchers, and healthcare professionals will benefit from the findings in developing targeted interventions to address the social determinants of TB/HIV comorbidity in sub-Saharan Africa.
Collapse
Affiliation(s)
- Lucas Banda
- Department of Public Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, Mthatha 5099, South Africa;
| | - Olanrewaju Oladimeji
- Department of Public Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, Mthatha 5099, South Africa;
- Department of Epidemiology and Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
| |
Collapse
|
4
|
Temitayo-Oboh AO, Sherif Azees A, Ohunene Amin J, Omobuwa O. The burden of TB/HIV co-infection among clients attending DOTs clinic in a tertiary centre in Southwestern, Nigeria: A 5-year retrospective study. J R Coll Physicians Edinb 2022; 52:307-312. [PMID: 36515613 DOI: 10.1177/14782715221142326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) and human immunodeficiency virus (HIV) are closely correlated and continue to cause deleterious effects in co-infected patients. This study aimed to determine the prevalence and associated factors of TB/HIV co-infection among directly observed treatment short-course (DOTs) clinic clients in Ogun State, Nigeria. METHODS The TB register and treatment cards of patients that visited the DOTs centre in Federal Medical Centre Abeokuta between January 2015 and December 2019 were reviewed. RESULTS A total of 726 TB patients' records were reviewed, among which 186 (22.5%) were co-infected with HIV. TB/HIV co-infection was significantly associated with the ⩽19 years age group 54 (37.2%), females 85 (26.7%), divorced and separated 8 (34.8%), rural residents 18 (34.0%), those who had no formal education 53 (39.8%) and the unemployed 63 (31.7%). Gender and educational status remained significant predictors of TB/HIV co-infection after adjustment for confounding factors. DISCUSSION Gender-sensitive programming and interventions geared towards improving knowledge of TB and HIV using a wide array of approaches should be considered.
Collapse
Affiliation(s)
| | - Ayotunde Sherif Azees
- Department of Community Medicine and Primary Care, Federal Medical Centre, Idi-Aba, Abeokuta, Ogun State, Nigeria
| | - Jamila Ohunene Amin
- Department of Public Health, Federal Ministry of Health, National Tuberculosis and Leprosy Control Programme (NTBLCP), FCT, Abuja, Nigeria
| | - Olubukunola Omobuwa
- Department of Community Medicine, Osun State University, Osogbo, Osun State, Nigeria
| |
Collapse
|
5
|
Ababu DG, Gobena WE, Getahun AM. Prevalence of Tuberculosis and the Determinants of Lose to Follow-Up the Treatment for Tuberculosis Patients in Case of Buno Bedele and Ilu Ababor Zones, Oromia, Ethiopia. Infect Drug Resist 2022; 15:5321-5329. [PMID: 36106054 PMCID: PMC9467688 DOI: 10.2147/idr.s373230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Tuberculosis (TB) is a potentially serious infectious disease that mainly affects the lungs. The bacteria, Mycobacterium tuberculosis (MTB), that cause tuberculosis are spread from one person to another person through tiny droplets released into the air via coughs and sneezes. The study aimed to investigate the prevalence of tuberculosis and determinants of lose to follow-up from TB treatment. Methods A retrospective study design is used to analyze the prevalence of tuberculosis and the determinants of lose to follow-up from TB treatment who follow the treatment from 2006 to 2017. The collected data were analyzed using descriptive statistics and statistical model. Results The study showed that among 375 TB patients, who started TB treatments, about 24.8% were lost to follow-up from TB treatment and 75.2% were censored at the end of the study. The median survival time of TB patients was 199 days. The results from the Log rank test showed that marital status, HIV co-infection, diabetes mellitus, cancer, and anemia cases had a significant difference between the survival experiences at a 5% level of significance. The result of the Cox-proportion hazard model showed that age (p-value=0.002; CI: (0.9831144, 0.9962526)), HIV co-infection (p-value=0.016; CI: (1.112293, 2.774715)), and anemia (p-value=0.021; CI: (1.089895, 2.938783)) had a significant effect on tuberculosis patients' lose to follow-up from TB treatment at a 5% level of significance. Conclusion From 375 patients who started TB treatments, about 24.8% were lost to follow-up from TB treatment, and 75.2% were censored at the end of the study. The median survival time of TB patients was 199 days. The variables marital status, HIV co-infection, diabetes mellitus, cancer, and anemia cases had a significant difference between the survival experiences survival time of TB patients at a 5% level of significance. The result also showed that age, HIV co-infection, and anemia had a significant effect on tuberculosis patients.
Collapse
Affiliation(s)
- Dereje Gebeyehu Ababu
- Department of Statistics, College of Natural Science, Salale University, Fitche, Ethiopia
| | - Woldemariam Erkalo Gobena
- Department of Statistics, College of Natural and Computational Sciences, Mettu University, Mettu, Ethiopia
| | - Azmeraw Misganaw Getahun
- Department of Statistics, College of Natural and Computational Sciences, Mettu University, Mettu, Ethiopia
| |
Collapse
|
6
|
Mengesha MM, Gebremichael MA, Watumo D, Hallström IK, Jerene D. Poor adult tuberculosis treatment outcome and associated factors in Gibe Woreda, Southern Ethiopia: An institution-based cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000161. [PMID: 36962264 PMCID: PMC10021194 DOI: 10.1371/journal.pgph.0000161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022]
Abstract
Tuberculosis (TB) remains a major medical and public health problem throughout the world, especially in developing countries including Ethiopia. Its control program is currently being challenged by the spread of drug-resistant TB, which is the result of poor treatment outcomes. Hence, this study assessed poor adult TB treatment outcomes and associated factors in Gibe Woreda, Southern Ethiopia. An institution-based cross-sectional study was conducted from March 1, 2020 to March 30, 2020, using a standard checklist to review clinical charts of TB patients who enrolled on first-line TB treatment under DOTS between June 2016 and June 2019. Poor treatment outcomes constituted death during treatment, treatment failure, and loss to follow-up (LTFU). Descriptive statistics were used to describe the characteristics of study participants. A binary logistic regression model was fitted to identify factors influencing treatment outcome and adjusted odds ratios with a 95% confidence interval were reported. The statistical significance of all tests in this study was declared at P-value <5%. A total of 400 adult TB patients were participated. The mean age of study participants was 39.2±16.7 years, 55.5% were males and 79.8% were pulmonary tuberculosis cases. Regarding the treatment outcomes, 58% completed treatment, 27.5% cured, 9.3% were LTFU, 3.2% died, and 2.0% failed. The overall poor treatment outcome was 14.5% (95% CI: 11.1-17.9). Age (aOR = 1.02; 95%CI: 1.01-1.04), male gender (aOR = 1.82; 95% CI: 0.99-3.73), travel ≥ 10 kilometres to receive TB treatment (aOR = 6.55; 95% CI: 3.02-14.19), and lack of family support during the course of treatment (aOR = 3.03; 95% CI: 1.37-6.70), and bedridden baseline functional status (aOR = 4.40; 95% CI: 0.96-20.06) were factors associated with poor treatment outcome. Successful TB treatment outcome in this study area was below the national TB treatment success rate. To improve positive treatment outcomes, remote areas should be prioritized for TB interventions, and stakeholders in TB treatment and care should give special emphasis to adults over the age of 45 years, males, those who travel more than 10 kilometres to receive TB care, having bedridden baseline functional status and those who had no family support.
Collapse
Affiliation(s)
- Melkamu Merid Mengesha
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Mathewos Alemu Gebremichael
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Desta Watumo
- Hadiya Zone Health Department, Hosanna, Ethiopia
| | | | - Degu Jerene
- Faculty of Medicine, Department of Health Sciences, Child and Family Health, Lund University, Lund, Sweden
- KNCV Tuberculosis Foundation, Den Haag, The Netherlands
| |
Collapse
|
7
|
Saati AA, Khurram M, Faidah H, Haseeb A, Iriti M. A Saudi Arabian Public Health Perspective of Tuberculosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10042. [PMID: 34639342 PMCID: PMC8508237 DOI: 10.3390/ijerph181910042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/30/2021] [Accepted: 09/16/2021] [Indexed: 12/02/2022]
Abstract
Tuberculosis is a global health challenge due to its spreading potential. The Kingdom of Saudi Arabia (KSA) faces a challenge in the spread of tuberculosis from migrant workers, but the foremost threat is the huge number of pilgrims who travel to visit sacred sites of the Islamic world located in the holy cities of Makkah and Al Madina. Pilgrims visit throughout the year but especially in the months of Ramadan and Zul-Hijah. The rise of resistance in Mycobacterium tuberculosis is an established global phenomenon that makes such large congregations likely hotspots in the dissemination and spread of disease at a global level. Although very stringent and effective measures exist, the threat remains due to the ever-changing dynamics of this highly pathogenic disease. This overview primarily highlights the current public health challenges posed by this disease to the Saudi health system, which needs to be highlighted not only to the concerned authorities of KSA, but also to the concerned global quarters since the pilgrims and migrants come from all parts of the world with a majority coming from high tuberculosis-burdened countries.
Collapse
Affiliation(s)
- Abdullah A. Saati
- Department of Community Medicine & Pilgrims Healthcare, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Muhammad Khurram
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Abasyn University, Peshawar 25000, Pakistan
| | - Hani Faidah
- Department of Microbiology, Faculty of Medicine, Umm Al Qura University, Makkah 24382, Saudi Arabia;
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah 24382, Saudi Arabia;
| | - Marcello Iriti
- Department of Agricultural and Environmental Sciences, Università degli Studi di Milano, 20133 Milano, Italy
- Phytochem Lab, Department of Agricultural and Environmental Sciences, Università degli Studi di Milano, 20133 Milano, Italy
- Center for Studies on Bioispired Agro-Environmental Technology (BAT Center), Università degli Studi di Napoli “Federico II”, 80055 Portici, Italy
- National Interuniversity Consortium of Materials Science and Technology (INSTM), 50121 Firenze, Italy
| |
Collapse
|
8
|
Wondimu W, Dube L, Kabeta T. Factors Affecting Survival Rates Among Adult TB/HIV Co-Infected Patients in Mizan Tepi University Teaching Hospital, South West Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:157-164. [PMID: 32368156 PMCID: PMC7185339 DOI: 10.2147/hiv.s242756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/07/2020] [Indexed: 11/23/2022]
Abstract
Background Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection was responsible for approximately 300,000 deaths worldwide in 2017. Despite this burden of death, factors associated with the survival of TB-HIV co-infected patients were not adequately studied; and some of the existing evidences are inconsistent. This study was aimed to identify factors associated with survival rates of TB/HIV co-infected patients. Methods The current study was a retrospective analysis of data extracted from 364 TB/HIV co-infected patients treated at Mizan Tepi University Teaching Hospital, Ethiopia, during the years 2007-2017. Time to event was measured from the date of TB treatment initiation till death, loss to follow-up or completion of treatment. Since the event was death, patients lost from follow-up and those on follow-up were considered as censored. Using Cox-regression, the 95% CI of hazard ratio (HR) and P-value <0.05 were used to identify the significant variables in multivariable analysis. Results All the 364 patients were followed up for 1654 person-months. There were 83 (22.8%) deaths and the majority, 38 (45.8%), were occurring within the first two months of anti-TB treatment initiation. The overall incidence rate and median survival time were 5.02 per 100 person-months (95% CI: 4.05, 6.22) and 10 months, respectively. Not using CPT (adjusted hazard ratio [AHR] =1.72; P=0.023), bedridden functional status (AHR=2.55; P=0.007), not disclosing HIV status (AHR=4.03; P<0.001) and CD4 < 200 cells/mm3 (AHR=6.05; P<0.001) were factors associated with survival rates of TB/HIV co-infected patients. Conclusion Our finding signals that care and attention should be given to the victims of these synergistic diseases. There is room to improve the survival of the patients if those with low CD4 count and bedridden functional status are closely monitored; and if CPT is promptly initiated with encouraging HIV status disclosure.
Collapse
Affiliation(s)
- Wondimagegn Wondimu
- Mizan Tepi University, College of Health Science, Department of Public Health, Mizan Aman, Ethiopia
| | - Lamessa Dube
- Jimma University, Faculty of Public Health, Department of Epidemiology, Jimma, Ethiopia
| | - Teshome Kabeta
- Jimma University, Faculty of Public Health, Department of Epidemiology, Jimma, Ethiopia
| |
Collapse
|
9
|
Rossetto M, Brand ÉM, Rodrigues RM, Serrant L, Teixeira LB. Factors associated with hospitalization and death among TB/HIV co-infected persons in Porto Alegre, Brazil. PLoS One 2019; 14:e0209174. [PMID: 30601842 PMCID: PMC6314623 DOI: 10.1371/journal.pone.0209174] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 12/02/2018] [Indexed: 12/27/2022] Open
Abstract
In locations with a high rate of tuberculosis (TB) and HIV infection, there are a number of strategies to prevent negative outcomes such as opportunistic infections, hospitalizations and death, and this article investigates risk factors for the occurrence of hospitalization and death in cases of TB/HIV co-infection in the south of Brazil. The data are taken from a population-based retrospective cohort study on cases of TB/HIV co-infection from 2009 to 2013 in Porto Alegre, Brazil. Sociodemographic, epidemiological and clinical variables were analyzed. Relative risk (RR) estimates for hospitalization and death were determined by regression models. There were 2,419 co-infection cases, of which 1,527 (63.1%) corresponded to hospitalizations, and 662 (27.4%) to death. The occurrence of hospitalization was associated with ≤ 7 years of schooling (RR = 3.47, 95%CI: 1.97–6.29), 8–11 years of schooling (RR = 2.56, 95%CI: 1.44–4.69), place of origin—district health authorities Northwest/Humaitá/Navegantes/Ilhas (RR = 2.01, 95%CI: 1.44–2.82), type of entry into the surveillance system as in cases of reentry after withdrawal (RR = 1,35, 95%CI: 1.07–1.70), closure in surveillance as in withdrawal of treatment (RR = 1.47, 95%CI: 1.18–1.83) and multidrug-resistant tuberculosis (RR = 3.94, 95%CI: 1.97–8.81). The occurrence of death was associated with age (RR = 1.07, 95%CI: 1,01–1,14), ≤ 7 years of schooling (RR = 3.94, 95%CI: 2.26–7.09), 8–11 years of schooling (RR = 2.84, 95%CI: 1.61–5.16), place of origin—district health authorities Baltazar (RR = 2.05, 95%CI: 1.48–2.86), type of entry in the surveillance system as cases of re-entry after withdrawal (RR = 1.53, 95%CI: 1.22–1.91), relapse (RR = 1.33, 95%CI: 1.03–1.73). The occurrence of hospitalizations and deaths is high among co-infected patients. Our estimation approach is important in order to identify, from the surveillance data, the risk factors for hospitalization and death in co-infected patients, so that they may receive more attention from the Brazilian national healthcare system.
Collapse
Affiliation(s)
- Maíra Rossetto
- Department of Medicine, Universidade Federal da Fronteira Sul, Chapecó, Santa Catarina, Brasil
| | - Évelin Maria Brand
- Department of Public Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Laura Serrant
- Faculty of Health and Wellbeing, Sheffield Hallam University, South Yorkshire, England, United Kingdom
| | - Luciana Barcellos Teixeira
- Department of Public Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| |
Collapse
|
10
|
Gesesew HA, Ward P, Woldemichael K, Mwanri L. Early mortality among children and adults in antiretroviral therapy programs in Southwest Ethiopia, 2003-15. PLoS One 2018; 13:e0198815. [PMID: 29912974 PMCID: PMC6005574 DOI: 10.1371/journal.pone.0198815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/27/2018] [Indexed: 12/21/2022] Open
Abstract
Background Several studies reported that the majority of deaths in HIV-infected people are documented in their early antiretroviral therapy (ART) follow-ups. Early mortality refers to death of people on ART for follow up period of below 24 months due to any cause. The current study assessed predictors of early HIV mortality in Southwest Ethiopia. Methods We have conducted a retrospective analysis of 5299 patient records dating from June 2003- March 2015. To estimate survival time and compare the time to event among the different groups of patients, we used a Kaplan Meir curve and log-rank test. To identify mortality predictors, we used a cox regression analysis. We used SPSS-20 for all analyses. Results A total of 326 patients died in the 12 years follow-up period contributing to 6.2% cumulative incidence and 21.7 deaths per 1000 person-year observations incidence rate. Eighty-nine percent of the total deaths were documented in the first two years follow up—an early-term ART follow up. Early HIV mortality rates among adults were 50% less in separated, divorced or widowed patients compared with never married patients, 1.6 times higher in patients with baseline CD4 count <200 cells/μL compared to baseline CD4 count ≥200 cells/μL, 1.5 times higher in patients with baseline WHO clinical stage 3 or 4 compared to baseline WHO clinical stage 1 or 2, 2.1 times higher in patients with immunologic failure compared with no immunologic failure, 60% less in patients with fair or poor compared with good adherence, 2.9 times higher in patients with bedridden functional status compared to working functional status, and 2.7 times higher with patients who had no history of HIV testing before diagnosis compared to those who had history of HIV testing. Most predictors of early mortality remained the same to the predictors of an overall HIV mortality. When discontinuation was assumed as an event, the predictors of an overall HIV mortality included age between 25–50 years, base line CD4 count, developing immunologic failure, bedridden functional status, and no history of HIV testing before diagnosis. Conclusions The great majority of deaths were documented in the first two years of ART, and several predictors of early HIV mortality were also for the overall mortality when discontinuation was assumed as event or censored. Considering the above population, interventions to improve HIV program in the first two years of ART follow up should be improved.
Collapse
Affiliation(s)
- Hailay Abrha Gesesew
- Public Health, Flinders University, Adelaide, Australia
- Epidemiology, Jimma University, Jimma, Ethiopia
- * E-mail:
| | - Paul Ward
- Public Health, Flinders University, Adelaide, Australia
| | | | | |
Collapse
|
11
|
Mekonnen E, Workicho A, Hussein N, Feyera T. Reasons and predictors for antiretroviral therapy change among HIV-infected adults at South West Ethiopia. BMC Res Notes 2018; 11:351. [PMID: 29871671 PMCID: PMC5989425 DOI: 10.1186/s13104-018-3470-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 06/01/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE This retrospective cohort study is aimed to assess reasons and predictors of regimen change from initial highly active antiretroviral therapy among 1533 Human Immunodeficiency virus-infected adult patients at the Jimma University Tertiary Hospital. RESULTS One in two (47.7%) adults changed their antiretroviral therapy regimen. Patients who were above the primary level of education [Hazard ratio (HR) 1.241 (95% CI 1.070-1.440)] and with human immunodeficiency virus/tuberculosis co-infection [HR 1.405 (95% CI 1.156-1.708)] had the higher risk of regimen change than their comparator. Individuals on Efavirenz [HR 0.675 (95% CI 0.553-0.825)] and non-stavudine [HR 0.494 (95% CI 0.406-0.601)] based regimens had lower risk of regimen change.
Collapse
Affiliation(s)
- Endalkachew Mekonnen
- Department of Medicine, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia.
| | - Abdulhalik Workicho
- Department of Epidemiology, College of Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Nezif Hussein
- School of Pharmacy, College of Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Teka Feyera
- Department of Veterinary Clinical Studies, College of Veterinary Medicine, Jigjiga University, Jigjiga, Ethiopia
| |
Collapse
|
12
|
Jiamsakul A, Yunihastuti E, Van Nguyen K, Merati TP, Do CD, Ditangco R, Ponnampalavanar S, Zhang F, Kiertiburanakul S, Lee MP, Avihingasanon A, NG OT, Sim BLH, Wong W, Ross J, Law M. Mortality following diagnosis of tuberculosis in HIV-infected patients in Asia. HIV Med 2018; 19:10.1111/hiv.12621. [PMID: 29683253 PMCID: PMC6201296 DOI: 10.1111/hiv.12621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Evy Yunihastuti
- Working Group on AIDS, Faculty of Medicine, University of Indonesia/ Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | | | | | | | | | - Fujie Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | | | - Man-Po Lee
- Queen Elizabeth Hospital, Hong Kong, China
| | - Anchalee Avihingasanon
- HIV-NAT, The Thai Red Cross AIDS Research Centre and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Oon Tek NG
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | | | - Wingwai Wong
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jeremy Ross
- TREAT Asia, amfAR – The Foundation for AIDS Research, Bangkok, Thailand
| | - Matthew Law
- The Kirby Institute, UNSW Sydney, NSW, Australia
| |
Collapse
|
13
|
Worku S, Derbie A, Mekonnen D, Biadglegne F. Treatment outcomes of tuberculosis patients under directly observed treatment short-course at Debre Tabor General Hospital, northwest Ethiopia: nine-years retrospective study. Infect Dis Poverty 2018; 7:16. [PMID: 29482637 PMCID: PMC6389154 DOI: 10.1186/s40249-018-0395-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 02/08/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Data regarding tuberculosis (TB) treatment outcomes, proportion of TB/HIV co-infection and associated factors have been released at different TB treatment facilities in Ethiopia and elsewhere in the world as part of the auditing and surveillance service. However, these data are missing for the TB clinic offering directly observed treatment short-course (DOTs) at Debre Tabor General Hospital (DTGH). METHODS The authors analysed the records of 985 TB patients registered at the DTGH from September 2008 to December 2016. Data on patients' sex, age, type of TB, and treatment outcomes were extracted from the TB treatment registration logbook. The treatment outcome of patients was categorized according to the National TB and Leprosy Control Program guidelines: cured, treatment completed, treatment failed, died, and not evaluated (transferred out and unknown cases). RESULTS Around half of the registered patients were males (516, 52.4%). In terms of TB types, 381 (38.7%), 241 (24.5%), and 363 (36.9%) patients had smear-negative pulmonary TB, smear-positive pulmonary TB, and extra pulmonary TB, respectively. Six hundred and seventy-two patients (90.1%) had successful treatment outcomes (cured and treatment completed), while 74 patients (9.9%) had unsuccessful treatment outcomes (death and treatment failure).TB treatment outcome was not associated with age, sex, type and history of TB, or co-infection with HIV (P > 0.05). The proportion of TB/HIV co-infection was at 24.2%, and these were found to be significantly associated with the age groups of 25-34, 35-44 and ≥65 years:(aOR: 0.44; 95% CI: 0.25-0.8), (aOR: 0.39; 95% CI: 0.20-0.70), (aOR: 4.2; 95% CI: 1.30-12.9), respectively. CONCLUSIONS The proportion of patients with successful treatment outcomes was above the World Health Organization target set for Millennium Development Goal of 85% and in line with that of the global milestone target set at > 90% for 2025. Relatively higher proportions of transfer-out cases were recorded in the present study. Similarly, the proportion of TB/HIV co-infection cases was much higher than the national average of 8%.Thus, the health facility under study should develop strategies to record the final treatment outcome of transfer-out cases. In addition, strategies to reduce the burden of TB/HIV co-infection should be strengthened.
Collapse
Affiliation(s)
- Seble Worku
- Department of Medical Laboratory Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Awoke Derbie
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 1383, Bahir Dar, Ethiopia
| | - Daniel Mekonnen
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 1383, Bahir Dar, Ethiopia
- Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
| | - Fantahun Biadglegne
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 1383, Bahir Dar, Ethiopia
| |
Collapse
|
14
|
Teklu AM, Nega A, Mamuye AT, Sitotaw Y, Kassa D, Mesfin G, Belayihun B, Medhin G, Yirdaw K. Factors Associated with Mortality of TB/HIV Co-infected Patients in Ethiopia. Ethiop J Health Sci 2018; 27:29-38. [PMID: 28465651 PMCID: PMC5402803 DOI: 10.4314/ejhs.v27i1.4s] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Despite the large number of TB patients on ART in Ethiopia, their mortality remains high. This study reports the effect of TB on HIV related mortality and determinants of TB/HIV co-infection related mortality. METHODS A longitudinal study design was employed as part of the Advanced Clinical Monitoring of ART (ACM) in Ethiopia. All patients started on ART at or after January 1, 2005 were included. Survival analysis was done to compare survival patterns of HIV patients with TB against HIV patients without TB. In addition, determinants of survival among TB/HIV co-infected patients were analyzed. Adjusted effects of the different factors on time to death were generated using Cox-proportional hazards regression. RESULTS A total of 3,889 patients were enrolled in the ACM study, of which 355 TB cases were identified, making the crude prevalence 9% (95% CI 8.3 - 10.2). Overall, incidence of TB was 2.2 (95% CI 1.9-2.4) per 100 person-years. TB was highest in the first 2 months and declined with time on ART to reach 1 per 100 person years after 24 months on ART. TB was significantly associated with mortality among HIV patients on HAART (AHR 2.0, 95% CI 1.47-2.75). Male gender was associated with mortality among TB/HIV co-infected patients. CONCLUSION Tuberculosis plays a key role in HIV associated mortality. Targeted interventions which can keep patients free of TB in the early stages of their treatment are required to reduce TB related mortality.
Collapse
Affiliation(s)
- Alula M Teklu
- Alula M. Teklu: MERQ Consultancy Services, Addis Ababa, Ethiopa
| | - Abiy Nega
- Abiy Nega: MERQ Consultancy Services, Addis Ababa, Ethiopia
| | - Admasu Tenna Mamuye
- Admasu Tenna Mamuye: Addis Ababa University, Medical Faculty, Addis Ababa, Ethiopia
| | - Yohannes Sitotaw
- Yohannes Sitotaw: Ministry of Science and Technology, Addis Ababa, Ethiopia
| | - Desta Kassa
- Desta Kassa: Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Getnet Mesfin
- Getnet Mesfin: Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bekele Belayihun
- Mekele Belayhiun: Ethiopian Public Health Association, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Girmay Medhin: Aklilu Lemma Institute of Pathobiology, Addis Ababa
| | | |
Collapse
|
15
|
Gesesew HA, Ward P, Woldemichael K, Mwanri L. Late presentation for HIV care in Southwest Ethiopia in 2003-2015: prevalence, trend, outcomes and risk factors. BMC Infect Dis 2018; 18:59. [PMID: 29378523 PMCID: PMC5789710 DOI: 10.1186/s12879-018-2971-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 01/19/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Early presentation for HIV care is vital as an initial tread in the UNAIDS 90-90-90 targets. However, late presentation for HIV care (LP) challenges achieving the targets. This study assessed the prevalence, trends, outcomes and risk factorsfor LP. METHODS A 12 year retrospective cohort study was conducted using electronic medical records extracted from an antiretroviral therapy (ART) clinic at Jimma University Teaching Hospital. LP for children refers to moderate or severe immune-suppression, or WHO clinical stage 3 or 4 at the time of first presentation to the ART clinics. LP for adults refers to CD4 lymphocyte count of < 200 cells/ μl and < 350 cells/μl irrespective of clinical staging, or WHO clinical stage 3 or 4 irrespective of CD4 count at the time of first presentation to the ART clinics. Binary logistic regression was used to identify factors that were associated with LP, and missing data were handled using multiple imputations. RESULTS Three hundred ninety-nine children and 4900 adults were enrolled in ART care between 2003 and 15. The prevalence of LP was 57% in children and 66.7% in adults with an overall prevalence of 65.5%, and the 10-year analysis of LP showed upward trends. 57% of dead children, 32% of discontinued children, and 97% of children with immunological failure were late presenters for HIV care. Similarly, 65% of dead adults, 65% of discontinued adults, and 79% of adults with immunological failure presented late for the care. Age between 25- < 50 years (AOR = 0.4,95% CI:0.3-0.6) and 50+ years (AOR = 0.4,95% CI:0.2-0.6), being female (AOR = 1.2, 95% CI: 1.03-1.5), having Tb/HIV co-infection (AOR = 1.6, 95% CI: 1.09-2.1), having no previous history of HIV testing (AOR = 1.2, 95% CI: 1.1-1.4), and HIV care enrollment period in 2012 and after (AOR = 0.8, 95% CI: 0.7-0.9) were the factors associated with LP for Adults. For children, none of the factors were associated with LP. CONCLUSIONS The prevalence of LP was high in both adults and children. The majority of both children and adults who presented late for HIV care had died and developed immunological failure. Effective programs should be designed and implemented to tackle the gap in timely HIV care engagement.
Collapse
Affiliation(s)
- Hailay Abrha Gesesew
- Public Health, Flinders University, Adelaide, Australia. .,Epidemiology, Jimma University, Jimma, Ethiopia.
| | - Paul Ward
- Public Health, Flinders University, Adelaide, Australia
| | | | | |
Collapse
|
16
|
Gesesew HA, Ward P, Woldemichael K, Mwanri L. Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015. PLoS One 2017; 12:e0179533. [PMID: 28622361 PMCID: PMC5473588 DOI: 10.1371/journal.pone.0179533] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 05/31/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is well acknowledged that antiretroviral therapy (ART) discontinuation hampers the progress towards achieving the UNAIDS treatment targets that aim to treat 90% of HIV diagnosed patients and achieve viral suppression for 90% of those on treatment. Nevertheless, the magnitude, trend and risk factors for ART discontinuation have not been explored extensively. We carried out a retrospective data analysis to assess prevalence, trend and risk factors for ART discontinuation among adults in Southwest Ethiopia. METHODS 12 years retrospective cohort analysis was performed with 4900 HIV-infected adult patients between 21 June 2003 and 15 March 2015 registered at the ART clinic at Jimma University Teaching Hospital. ART discontinuation could be loss to follow-up, defaulting and/or stopping medication while remaining in care. Because data for 2003 and 2015 were incomplete, the 10 years data were used to describe trends for ART discontinuation using a line graph. We used binary logistic regression to identify factors that were correlated with ART discontinuation. To handle missing data, we applied multiple imputations assuming missing at random pattern. RESULTS In total, 4900 adult patients enrolled on ART, of whom 1090 (22.3%) had discontinued, 954 (19.5%) had transferred out, 300 (6.1%) had died, 2517 (51.4%) were alive and on ART, and the remaining 39 (0.8%) had unknown outcome status. The trend of ART discontinuation showed an upward direction in the recent times and reached a peak, accounting for a magnitude of 10%, in 2004 and 2005. Being a female (AOR = 2.1, 95%CI: 1.7-2.8), having an immunological failure (AOR = 2.3, 1.9-8.2), having tuberculosis/HIV co-infection (AOR = 1.5, 1.1-2.1) and no previous history of HIV testing (AOR = 1.8, 1.4-2.9) were the risk factors for ART discontinuation. CONCLUSIONS One out of five adults had discontinued from ART, and the trend of ART discontinuation increased recently. Discontinued adults were more likely to be females, tuberculosis/HIV co-infected, with immunological failure and no history of HIV testing. Therefore, it is vital to implement effective programs such as community ART distribution and linkage-case-management to enhance ART linkage and retention.
Collapse
Affiliation(s)
- Hailay Abrha Gesesew
- Public Health, Flinders University, Adelaide, Australia
- Epidemiology, Jimma University, Jimma, Ethiopia
| | - Paul Ward
- Public Health, Flinders University, Adelaide, Australia
| | | | | |
Collapse
|
17
|
Yoko JLM, Tumbo JM, Mills AB, Kabongo CD. Characteristics of pulmonary tuberculosis patients in Moses Kotane region North West Province, South Africa. S Afr Fam Pract (2004) 2017. [DOI: 10.1080/20786190.2016.1272249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- JLM Yoko
- Department of Family Medicine and PHC, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - JM Tumbo
- Department of Family Medicine and PHC, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - AB Mills
- Department of Family Medicine and PHC, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - CD Kabongo
- Department of Family Medicine and PHC, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| |
Collapse
|
18
|
Sinshaw Y, Alemu S, Fekadu A, Gizachew M. Successful TB treatment outcome and its associated factors among TB/HIV co-infected patients attending Gondar University Referral Hospital, Northwest Ethiopia: an institution based cross-sectional study. BMC Infect Dis 2017; 17:132. [PMID: 28178936 PMCID: PMC5299781 DOI: 10.1186/s12879-017-2238-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 02/02/2017] [Indexed: 11/26/2022] Open
Abstract
Background Tuberculosis/Human immunodeficiency virus (TB/HIV) co-infection is bidirectional and synergistic which mainly affects interventions that have been taken on the area. Tb patients co-infected with HIV have poorer treatment outcome as compared to non-co-infected patients. There is limited information regarding successful TB treatment outcomes and its associated factors; a reason that this study was planned to investigate. Methods An institution based cross sectional study was carried out from July 2010 to January 2016. Data were abstracted from patients’ medical chart using data abstraction format. The completeness of the data was checked and cleaned manually. Then, it was entered and analyzed by using SPSS version 20.0. Bi-variable and Multi-variable logistic regression model was fitted to identify factors associated with successful Tb treatment outcome. Significance was obtained through adjusted odds ratio with its 95% CI and a p < 0.05. Results Successful TB treatment outcome among TB/HIV co-infected patients in Gondar University Hospital was 77.3% [95%CI 72.6–81.9]. Being residing in outside the Gondar town [AOR = 0.44, 95%CI: 0.25–0.80], having less than the mean baseline weight (<43.7 kg) at initiation of TB treatment [AOR = 0.51, 95% CI: 0.29–0.89], being in the bedridden condition [AOR = 0.23, 95% CI: 0.1–0.23], and experiencing anti-TB treatment side effect [AOR = 0.35, 95% CI: 0.12–0.98] were the factors that resulted the patient in treatment failure. Conclusion Successful Tb treatment outcome among TB/HIV co-infected patients was lower than the target set by Global Plan to Stop TB 2011–2015. Strengthening collaborative TB/HIV management activities that would trace the identified factors shall be recommended to increase successful treatment outcome of TB.
Collapse
Affiliation(s)
| | - Shitaye Alemu
- University of Gondar referral Hospital, Gondar, Ethiopia
| | - Abel Fekadu
- Department of Epidemiology and Biostatistics, University of Gondar, Institute of Public Health, Gondar, Ethiopia.
| | - Mucheye Gizachew
- University of Gondar, College of Medicine and Health Science, School of Biomedical Sciences, Gondar, Ethiopia
| |
Collapse
|
19
|
The prevalence and associated factors for delayed presentation for HIV care among tuberculosis/HIV co-infected patients in Southwest Ethiopia: a retrospective observational cohort. Infect Dis Poverty 2016; 5:96. [PMID: 27802839 PMCID: PMC5090949 DOI: 10.1186/s40249-016-0193-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/31/2016] [Indexed: 01/29/2023] Open
Abstract
Background A delay presentation for human immunodeficiency virus (HIV) patient’s care (that is late engagement to HIV care due to delayed HIV testing or delayed linkage for HIV care after the diagnosis of HIV positive) is a critical step in the series of HIV patient care continuum. In Ethiopia, delayed presentation (DP) for HIV care among vulnerable groups such as tuberculosis (Tb) /HIV co-infected patients has not been assessed. We aimed to assess the prevalence of and factors associated with DP (CD4 < 200 cells/μl at first visit) among Tb/HIV co-infected patients in southwest Ethiopia. Methods A retrospective observational cohort study collated Tb/HIV data from Jimma University Teaching Hospital for the period of September 2010 and August 2012. The data analysis used logistic regression model at P value of ≤ 0.05 in the final model. Results The prevalence of DP among Tb/HIV co-infected patients was 59.9 %. Tb/HIV co-infected patients who had a house with at least two rooms were less likely (AOR, 0.5; 95 % CI: 0.3–1.0) to present late than those having only single room. Tobacco non-users of Tb/HIV co-infected participants were also 50 % less likely (AOR, 0.5; 95 % CI: 0.3–0.8) to present late for HIV care compared to tobacco users. The relative odds of DP among Tb/HIV co-infected patients with ambulatory (AOR, 1.8; 95 % CI, 1.0–3.1) and bedridden (AOR, 8.3; 95 % CI, 2.8–25.1) functional status was higher than with working status. Conclusions Three out of five Tb/HIV co-infected patients presented late for HIV care. Higher proportions of DP were observed in bedridden patients, tobacco smokers, and those who had a single room residence. These findings have intervention implications and call for effective management strategies for Tb/HIV co-infection including early HIV diagnosis and early linkage to HIV care services. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0193-y) contains supplementary material, which is available to authorized users.
Collapse
|
20
|
Ntoumi F, Kaleebu P, Macete E, Mfinanga S, Chakaya J, Yeboah-Manu D, Bates M, Mwaba P, Maeurer M, Petersen E, Zumla A. Taking forward the World TB Day 2016 theme 'Unite to End Tuberculosis' for the WHO Africa Region. Int J Infect Dis 2016; 46:34-7. [PMID: 26969406 PMCID: PMC7110434 DOI: 10.1016/j.ijid.2016.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis (TB) has remained a global emergency ever since it was declared as such by the World Health Organization (WHO) in 1993. Of the 9.6 million people who developed TB in 2014, 28% were in the WHO Africa Region, where the case rate was 281 per 100 000 population. An estimated 1.2 million (12%) TB cases were HIV-positive and the Africa Region accounted for 74% of these cases. The global spread of multidrug-resistant TB (MDR-TB) is now a major public health challenge. Scientific, political, and funder communities seriously need to ‘Unite to End TB’, the theme of the 2016 World TB Day. TB control programs in Africa can only succeed if mechanisms for close engagement of developing country scientists, healthcare workers, patient groups, governments, and policy-makers are ensured by funding and donor agencies. Several funder, political, and community initiatives provide hope for achieving the goals of the WHO post-2015 TB strategy. TB activities and funder investments in Africa need to be aligned in parallel with international efforts at improving social and living conditions and with the ‘one health’ initiative.
Tuberculosis (TB) remains a global emergency, with an estimated 9.6 million new TB cases worldwide reported in 2014. Twenty-eight percent of these cases were in the World Health Organization (WHO) Africa Region, where the annual case detection rate was 281 per 100 000 population—more than double the global average of 133 per 100 000. Of the 9.6 million people who developed TB, an estimated 1.2 million (12%) were HIV-positive, and the Africa Region accounted for 74% of these cases. Three million people with TB remain undiagnosed and untreated. Globally, an estimated 480 000 had multidrug-resistant TB (MDR-TB). Whilst of the African countries, only South Africa has reported a high prevalence of MDR-TB, it is likely that all of Sub-Saharan Africa has an unreported high load of drug-resistant TB. Tragically, in 2014, only 48% of individuals diagnosed with MDR-TB had successful treatment and an estimated 190 000 people died of MDR-TB. Of the global TB funding gap of US$ 0.8 billion, the largest funding gap was in the Africa Region, amounting to US$ 0.4 billion in 2015. The MDR-TB pandemic in particular now threatens to devastate entire regions and may fundamentally alter the life-expectancy and demographic profile of many countries in Sub-Saharan Africa. The theme designated for this year's World TB Day, March 24, 2016, is ‘Unite to End TB’. From the Africa Region, there is an urgent need to seriously address the political, economic, and social factors that influence host–Mycobacterium tuberculosis interactions and result in disease. Recent political and funder initiatives that provide renewed hope for the alleviation of Africa's TB and TB/HIV problems are discussed.
Collapse
Affiliation(s)
- Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale, Brazzaville, Republic of Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany.
| | - Pontiano Kaleebu
- Uganda Virus Research Institute Research Unit on AIDS, Entebbe, Uganda
| | - Eusebio Macete
- Centro de Investigação em Saude de Manhiça, and National Directare of Public Health, Ministry of Health, Maputo, Mozambique
| | - Sayoki Mfinanga
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Jeremiah Chakaya
- Department of Medicine, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya
| | | | - Matthew Bates
- UNZA-UCLMS Research and Training Project, University Teaching Hospital, Lusaka, Zambia
| | - Peter Mwaba
- UNZA-UCLMS Research and Training Project, University Teaching Hospital, Lusaka, Zambia; Ministry of Health, Lusaka, Zambia
| | - Markus Maeurer
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, and Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Eskild Petersen
- University of Aarhus, Aarhus, Denmark; The Royal Hospital, Muscat, Oman
| | - Alimuddin Zumla
- UNZA-UCLMS Research and Training Project, University Teaching Hospital, Lusaka, Zambia; Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|