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Gebremichael G, Tadele N, Gebremedhin KB, Mengistu D. Opportunistic infections among people living with HIV/AIDS attending antiretroviral therapy clinics in Gedeo Zone, Southern Ethiopia. BMC Res Notes 2024; 17:225. [PMID: 39148100 PMCID: PMC11325715 DOI: 10.1186/s13104-024-06888-4] [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] [Received: 04/11/2024] [Accepted: 08/05/2024] [Indexed: 08/17/2024] Open
Abstract
INTRODUCTION Opportunistic infections (OIs) are more common and severe among people with suppressed immunity like those living with HIV/AIDS (PLWH). This study aimed to assess the prevalence of OIs and associated factors among PLWH attending antiretroviral therapy (ART) clinics in the Gedeo zone, Southern Ethiopia. METHODS A facility based retrospective cohort study was conducted from April to June 2018 among PLWH attending ART clinics in Gedeo zone, Ethiopia from November 2016 - November 2017. A simple random sampling method was used to select the both paper based and electronic study participants' charts. Adjusted odds ratios were calculated using multivariable logistic regression analysis for variables statistically significant at 95% confidence interval under bivariable logistic regression analysis, and significance was declared at P < 0.05. RESULTS a total of 266 PLWH attended the selected ART clinics of Gedeo zone during the one year period were participated in the current study. The majority 104(39.1%) were within the age group 30-39, 106(60.2%) male, 184(69.2%) married, and 167(62.9%) urban residents. The study revealed the prevalence of OIs was 113(42.5%) with oral candidiasis 28(24.5%) the most prevalent followed by pulmonary tuberculosis 22(19.5%) and herpes zoster 15(13.4%). Further, study participants with ambulatory [AOR = 2.40(95% CI: 1.14, 5.03)], and bedridden [AOR = 3.27(95% CI:1.64, 6.52)] working functional status; with lower CD4 count: less than 200cells/mm3 [AOR = 9.14(95% CI: 2.75, 30.39)], 200-350cells/mm3 [AOR = 9.45(95% CI: 2.70,33.06)], 351-500cells/mm3 [AOR = 5.76(95% CI: 1.71, 19.39)]; being poor in ART adherence level [AOR = 10.05(95% CI: 4.31,23.46)]; being in stage III/IV WHO clinical stage of HIV/AIDS [AOR = 2.72(95% CI: 1.42, 5.20)]; and being chewing khat [AOR = 2.84(95% CI: 1.21, 6.65)] were found positively predicting the occurrence of OIs. CONCLUSION This study speckled a high prevalence of OIs with several predicting factors. Therefore, the study acmes there should be interventional means which tackles the higher prevalence of OIs with focus to the predicting factors like lower CD4 count level, less/bedridden working functional status, poor ART adherence level, advanced stage of HIV/AIDS stage and chewing khat.
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Affiliation(s)
| | - Niguse Tadele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Daniel Mengistu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Asefa A, Bolka H, Woldesemayat EM. Determinants of tuberculosis among adult people living with HIV on antiretroviral therapy at public hospitals in Hawassa City, South Ethiopia. FRONTIERS IN EPIDEMIOLOGY 2024; 4:1353760. [PMID: 38638270 PMCID: PMC11025533 DOI: 10.3389/fepid.2024.1353760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/26/2024] [Indexed: 04/20/2024]
Abstract
Background The burden of tuberculosis (TB)/HIV co-infection is high in sub-Saharan African countries. The aim of the present study was to identify determinants of TB among people living with HIV (PLHIV) on antiretroviral therapy (ART) at public hospitals in Hawassa City Administration, Sidama Region, Ethiopia. Methods A facility-based case-control study was conducted between 30 March and 30 April 2023. We employed a systematic random sampling to recruit participants. The cases were all adult PLHIV who developed TB after ART initiation, and the group without TB were all adult PLHIV who did not develop TB after their ART initiation. Data were collected from patients' medical records using Kobo-tool and then exported to SPSS Version 26 for analysis. A multivariable logistic regression was used to identify the predictors of TB. Statistical significance was defined using the 95% confidence interval (CI). Result A total of 124 cases and 249 people without TB participated in the study. In a multivariable logistic regression analysis, we identified five independent determinants of TB. These include age (adjusted odds ratio (AOR) = 2.7; 95% CI 1.4-5.2), patients' residency (AOR = 6.4; 95% CI 2.8-14.5), WHO clinical stage III or IV (AOR = 6.7; 95% CI 3.2-14.0), isoniazid plus rifapentine (3HP) prophylaxis using (AOR = 0.5; 95% CI 0.2-0.9), and having other opportunistic infections (AOR = 3.6; 95% CI 1.7-7.6). Conclusion and recommendation Several risk factors for TB were identified among PLHIV. Strengthening TB screening in advanced disease conditions, encouraging use of 3HP prophylaxis, and early diagnosis and treatment of opportunistic infections were recommended to reduce the incidence of TB among PLHIV.
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Tsegaye D, Wude S, Kebede T, Adane S, Shumet T, Kebede F. Epidemiological survival pattern, risk factors, and estimated time to develop tuberculosis after test and treat strategies declared for children living with human immune deficiency virus. Indian J Tuberc 2023; 70 Suppl 1:S89-S99. [PMID: 38110268 DOI: 10.1016/j.ijtb.2023.05.008] [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] [Received: 04/07/2023] [Revised: 04/26/2023] [Accepted: 05/10/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Due to their age category and the immune-suppressing effects of HIV, children were more vulnerable to experience endogenous reactivation of latent bacilli in the lung and increased risk of active tuberculosis incidence. The aim of this study is to assess the survival pattern, risk factors, and estimated time to develop TB after children started ART at selected health facilities of North Wollo, Ethiopia, from November 1, to September 30, 2021. METHODS Facility-based retrospective cohort study was employed from November 1 to September 30, 2021. Cox proportional hazard regression model was used to assess factors associated with incidence of tuberculosis. AHR with 95% CI was used to declare statistical significance for tuberculosis incidence. RESULTS During follow-up, 54 (10.9%) new cases of tuberculosis was reported. At the end of follow-up period, overall cumulative survival probability was determined as 43.8% (95%CI: 28.2-54.3). WHO clinical stage III&IV (AHR: 2.4 (95% CI: 1.4, 4.7), Hgb≤10 gm/dl (AHR = 2.2: (95%CI: 1.12-5.8), missed isoniazid preventive therapy (AHR = 2.5 (95%CI: 1.56-10.3) and Viral Load (≥400 cell/ml) (AHR = 2.02 (95%CI: 2.03-6.8) were significant risk factors for tuberculosis incidence. CONCLUSION Nearly ten % of HIV-positive children experienced new cases of tuberculosis with median time of 25(IQR = ±12) months. It would be better to give special attention to children who missed isoniazid preventive therapy with WHO stages III&IV Viral load (≥400 cells/ml), and Hgb≤10 gm/dl to prevent tuberculosis incidence and prolonged quality of life.
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Affiliation(s)
- Dejen Tsegaye
- Debre Markos University, College of Health Sciences, Department of Nursing, Ethiopia.
| | - Sintayehu Wude
- Pawi general hospital, Department of Psychiatry, Metekel zone, Ethiopia
| | - Tsehay Kebede
- Bahir Dare University, Faculty of Social Science, Department of Geography, Ethiopia
| | - Setamlak Adane
- Woldia University, College of Health Science, Department of Epidemiology, Ethiopia
| | - Tesfaye Shumet
- Woldia University, College of Health Science, Department of Epidemiology, Ethiopia
| | - Fassikaw Kebede
- Woldia University, College of Health Science, Department of Epidemiology, Ethiopia
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Prevalence and factors associated with tuberculosis among the mining communities in Mererani, Tanzania. PLoS One 2023; 18:e0280396. [PMID: 36920939 PMCID: PMC10016659 DOI: 10.1371/journal.pone.0280396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 12/27/2022] [Indexed: 03/16/2023] Open
Abstract
Tuberculosis (TB) is among diseases of global health importance with Sub Saharan Africa (SSA) accounting for 25% of the global TB burden. TB prevalence among miners in SSA is estimated at 3,000-7,000/100,000, which is about 3 to 10-times higher than in the general population. The study's objective was to determine the prevalence of TB and associated risk factors among mining communities in Mererani, northern Tanzania. This was a cross-sectional study conducted from April 2019 to November 2021 involving current Small Scale Miners (SSM) and the General Community (GC). A total of 660 participants, 330 SSM and 330 GC were evaluated for the presence of TB. Data were analysed using Statistical Package for the Social Sciences (SPSS) database (IBM SPSS Statistics Version 27.0.0.0). Binary logistic regression (Generalized Linear Mixed Model) was used to determine the association between TB and independent predictors. Prevalence of TB was 7%, about 24-times higher than the national prevalence of 0.295%. Participants from the general community had higher prevalence of TB 7.9% than SSM (6.1%). Both for SSM and the GC, TB was found to be associated with: lower education level (aOR = 3.62, 95%CI = 1.16-11.28), previous lung disease (aOR = 4.30, 95%CI = 1.48-12.53) and having symptoms of TB (aOR = 3.24, 95%CI = 1.38-7.64). Specifically for the SSM, TB was found to be associated with Human Immunodeficiency Virus (HIV) infection (aOR = 8.28, 95%CI = 1.21-56.66). Though significant progress has been attained in the control of the TB epidemic in Tanzania, still hot spots with significantly high burden of TB exists, including miners. More importantly, populations surrounding the mining areas, are equally affected, and needs more engagement in the control of TB so as to realize the Global End TB targets of 2035.
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Prevalence, associated factors and Rifampicin Resistance pattern of Pulmonary Tuberculosis among HIV-positive patients attending Antiretroviral Treatment Clinic at East Gojjam Zone, Ethiopia: An Institution-based Cross-Sectional study. J Clin Tuberc Other Mycobact Dis 2022; 29:100336. [DOI: 10.1016/j.jctube.2022.100336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gisso BT, Hordofa MW, Ormago MD. Prevalence of pulmonary tuberculosis and associated factors among adults living with HIV/AIDS attending public hospitals in Shashamene Town, Oromia Region, South Ethiopia. SAGE Open Med 2022; 10:20503121221122437. [PMID: 36093423 PMCID: PMC9459465 DOI: 10.1177/20503121221122437] [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: 01/15/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: This study was aimed to assess the prevalence of pulmonary tuberculosis and
its associated factors among adults living with HIV/AIDS attending Public
Hospitals, Shashamene Town, Oromia Region, South Ethiopia. Methods: A cross-sectional study was conducted from November 2020 to February 2021
among Adults Living with HIV/AIDS attending Public Hospitals in Shashamene
Town, Oromia Region, South Ethiopia. A sputum sample was collected and
analyzed using Xpert MTB/RIF assay and blood sample was collected to count
CD4 using BD FACSPresto analyzer. Semi-structured questionnaires were used
to collect data. SPSS version 25 software was used for statistical analysis
and a p value of <0.05 was considered as statistically significant. Results: In this study, the overall prevalence of pulmonary tuberculosis among adults
living with HIV/AIDS attending the Public Hospitals was 23.5% (5% confidence
interval: 18.26, 29.13). Variables such as age range of 50–64 years, female
gender, occupation with house wife, and World Health Organization stage (III
and IV) were significantly associated with prevalence of tuberculosis
infection. Conclusion: The prevalence of tuberculosis in our study site was high. There is a need
for regular screening of people living with HIV/AIDS for TB using highly
sensitive method like Xpert MTB/RIF assay to know their TB status as well as
early commencement of anti-TB.
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Affiliation(s)
- Belayneh Tadesse Gisso
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Mesfin Worku Hordofa
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Moges Desta Ormago
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Geremew D, Geremew H, Tamir M, Adem M, Tegene B, Bayleyegn B. Tuberculosis and isoniazid prophylaxis among adult HIV positive patients on ART in Northwest Ethiopia. PLoS One 2022; 17:e0266803. [PMID: 35452463 PMCID: PMC9032379 DOI: 10.1371/journal.pone.0266803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 03/29/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Although antiretroviral therapy (ART) can avert tuberculosis (TB) incidence among human immunodeficiency virus (HIV) infected patients, the concomitant use of ART with isoniazid (INH) has a paramount effect. Despite this evidence, there is a paucity of data regarding TB incidence among HIV patients on ART with and without isoniazid prophylaxis and its predictors. Thus, this study sought to assess the incidence and predictors of TB among adult HIV positive patients on ART.
Methods
This was a hospital based retrospective study including 368 adult HIV positive patients on ART in Gondar comprehensive specialized hospital between January 1, 2016, and April 30, 2019. Data was extracted from clinical laboratory and HIV care ART follow up clinic. The bi-variable and multivariable regression models were used to ascertain predictors of incident TB. Data was analyzed using SPSS version 20 software.
Results
A total of 335 adult HIV positive patients were included in the analysis, of whom, 56 (16.7%) were developed incident TB. Being ambulatory and bedridden (AOR: 2.2, 95% CI: 1.1, 4.6), advanced WHO clinical HIV disease stage (III and IV) (AOR: 3.2, 95% CI: 1.6, 6.1), not taking INH (AOR: 2.8, 95% CI: 1.3, 5.9), and baseline CD4+ T cell count ≤ 200 cell/mm3 (AOR: 3.6, 95% CI: 1.8, 7.2) were found to be the predictors of tuberculosis incidence.
Conclusion
The study indicated a high TB incidence among HIV positive patients in Gondar. Therefore, scaling up the isoniazid preventive therapy program and its strict compliance is necessary to avert HIV fueled tuberculosis in HIV endemic areas.
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Affiliation(s)
- Demeke Geremew
- Department of Medical Laboratory Sciences, Immunology and Molecular Biology Unit, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- * E-mail:
| | - Habtamu Geremew
- College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | - Mebratu Tamir
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Adem
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Birhanemeskel Tegene
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Biruk Bayleyegn
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Chen J, Li L, Chen T, Yang X, Ru H, Li X, Yang X, Xie Q, Xu L. Predicting the risk of active pulmonary tuberculosis in people living with HIV: development and validation of a nomogram. BMC Infect Dis 2022; 22:388. [PMID: 35439965 PMCID: PMC9019965 DOI: 10.1186/s12879-022-07368-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 04/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnosis of pulmonary tuberculosis (PTB) among people living with HIV (PLHIV) was challenging. The study aimed to develop and validated a simple, convenient screening model for prioritizing TB among PLHIV. METHODS The study included eligible adult PLHIV participants who attended health care in Yunnan, China, from January 2016 to July 2019. Participants included before June 2018 were in the primary set; others were in the independent validation set. The research applied the least absolute shrinkage and selection operator regression to identify predictors associated with bacteriological confirmed PTB. The TB nomogram was developed by multivariate logistic regression. The C-index, receiver operating characteristic curve (ROC), the Hosmer-Lemeshow goodness of fit test (H-L), and the calibration curves were applied to evaluate and calibrate the nomogram. The developed nomogram was validated in the validation set. The clinical usefulness was assessed by cutoff analysis and decision curve analysis in the primary set. RESULT The study enrolled 766 PLHIV, of which 507 were in the primary set and 259 in the validation set, 21.5% and 14.3% individuals were confirmed PTB in two sets, respectively. The final nomogram included 5 predictors: current CD 4 cell count, the number of WHO screen tool, previous TB history, pulmonary cavity, and smoking status (p < 0.05). The C-statistic was 0.72 (95% CI 0.66-0.77) in primary set and 0.68 (95% CI 0.58-0.75) in validation set, ROC performed better than other models. The nomogram calibration was good (H-L χ2 = 8.14, p = 0.15). The area under the decision curve (0.025) outperformed the existing models. The optimal cutoff for screening TB among PLHIV was the score of 100 (sensitivity = 0.93, specificity = 0.35). CONCLUSION The study developed and validated a discriminative TB nomogram among PLHIV in the moderate prevalence of TB and HIV. The easy-to-use and straightforward nomogram would be beneficial for clinical practice and rapid risk screening in resource-limited settings.
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Affiliation(s)
- Jinou Chen
- Division of Tuberculosis Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Ling Li
- Family Health International Office, Kunming, China
| | - Tao Chen
- Division of Tuberculosis Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Xing Yang
- Division of Tuberculosis Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Haohao Ru
- Division of Tuberculosis Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Xia Li
- Yunnan Provincial Hospital of Infectious Disease, Kunming, China
| | - Xinping Yang
- Yunnan Provincial Hospital of Infectious Disease, Kunming, China
| | - Qi Xie
- Yunnan Provincial Hospital of Infectious Disease, Kunming, China
| | - Lin Xu
- Division of Tuberculosis Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, China.
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Incidence and Predictors of Pulmonary Tuberculosis among Children Who Received Antiretroviral Therapy (ART), Northwest Ethiopia: A Multicenter Historical Cohorts Study 2009–2019. J Trop Med 2022; 2022:9925693. [PMID: 35132323 PMCID: PMC8817833 DOI: 10.1155/2022/9925693] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/28/2021] [Accepted: 01/08/2022] [Indexed: 02/07/2023] Open
Abstract
The human immune deficiency virus (HIV) is the strongest risk factor for endogenous reactivation of pulmonary tuberculosis (PTB) through target reduction of CD4, T-lymphocytes, and cellular immune function. Almost one-third of deaths among people living with HIV are attributed to tuberculosis. Despite this evidence, in Ethiopia, information is scarce and meager regarding PTB incidence after ART initiated for seropositive children. Methods. Facility-based multicenter historical cohort was conducted among 721 seropositive children after initiating ART from January 1, 2009, to December 31, 2019. Data from the records of children were extracted using a standardized checklist. The collected data were entered using Epi-Data version 4.2 and exported to STATA (SE) R-14 version statistical soft wares for further analysis. Bivariable and multivariable Cox regression analyses were conducted to identify predictors of PTB incidence. Results. Seven hundred twenty-one (N = 721) seropositive children were included with a mean (±SD) age of 118.4 ± 38.24 months. During the follow-up periods, 63 (15.2%) participants developed new cases of TB; majority (61/63, 96.8%) of them were PTB. The overall incidence rate and the median (±IQR) time of PTB reported were determined as 5.86 per 100 child years (95% CI: 4.58, 7.5) and 17.8 (±11) months, respectively. At baseline, children being severely stunted (AHR = 2.9 : 95% CI, 1.2–7.8, P=0.03), with Hgb ≤10 mg/dl (AHR = 4.0; 95% CI, 2.1–8.1, P=0.001), and not given isoniazid and cotrimoxazole preventive therapy (AHR = 2.4; 95% CI: 1.2; 5.1, P=0.001) (AHR = 2.5; 95% CI, 1.4–4.7, P=0.021) were significantly associated with PTB incidence. Conclusion. A high incidence rate of PTB was observed in our study as compared with the previous finding in Ethiopia. Cases at baseline not taking IPT and CPT, being severely stunted, and having low hemoglobin (≤10 mg/dl) levels were found to be at higher risk of developing PTB.
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Mulugeta T, Takale A, Umeta B, Terefe B. Active TB infection and its associated factors among HIV-1 infected patients at Jimma medical center, Southwest Ethiopia. J Pharm Health Care Sci 2021; 7:44. [PMID: 34865659 PMCID: PMC8647564 DOI: 10.1186/s40780-021-00228-5] [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: 07/21/2021] [Accepted: 10/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background Human immune deficiency virus (HIV) increases the susceptibility to primary infection or reinfection and the risk of tuberculosis (TB) reactivation for patients with latent TB. There was no current report on the rate of active TB infection among HIV-1 infected patients in our teaching and referral hospital. Therefore, this study was aimed to determine the prevalence and factors associated with active TB infection among HIV-1 infected patients. Methods Hospital-based retrospective cross-sectional study was conducted at the Anti-Retroviral Therapy (ART) chronic follow-up clinic. Systematic random sampling was used to include the patients. A structured questionnaire was used to collect data. Data were analyzed using SPSS version 25. Descriptive statistics were used to describe the findings and multivariate logistic regression was performed to identify factors associated with active TB infection. Result 150 HIV-1 infected patients (female 54.7%) were included. The median (interquartile range, IQR) age of the patients was 33.5 (25.7, 40.0) years. Twenty-six (17.3%) of the patients had developed active TB infection, which was independently associated with the WHO clinical stage III and IV (AOR: 9.67, 95% confidence interval (CI); 2.21–42.37), p = 0.003). The use of isoniazid preventive therapy (IPT) (AOR: 0.123, 95CI; 0.034–0.44, p = 0.001) and having good adherence to ART medications (AOR: 0.076, 95CI; 0.007–0.80, p = 0.032) was associated with the reduced risk of active TB infection among HIV-1 infected patients. Conclusions Advanced WHO clinical stages increased the risk of active TB infection, while the use of IPT and good adherence to ART medications reduced the risk of active TB infection. Therefore, patients with advanced WHO clinical stage should be screened for TB infection, and starting IPT for the candidate patients should be strengthened to reduce the burden of active TB incidence. ART medication adherence should also be supported.
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Affiliation(s)
- Temesgen Mulugeta
- Department of Clinical Pharmacy, School of Pharmacy, Jimma University, Jimma, Oromia, Ethiopia.
| | - Alazar Takale
- Department of Clinical Pharmacy, School of Pharmacy, Jimma University, Jimma, Oromia, Ethiopia
| | - Belachew Umeta
- Department of Pharmaceutical Sciences, School of Pharmacy, Jimma University, Jimma, Oromia, Ethiopia
| | - Behailu Terefe
- Department of Clinical Pharmacy, School of Pharmacy, Jimma University, Jimma, Oromia, Ethiopia
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Abdu M, Ali Y, Anteneh S, Yesuf M, Birhanu A, Mohamed S, Hussien A. Determinant factors for the occurrence of tuberculosis after initiation of antiretroviral treatment among adult patients living with HIV at Dessie Referral Hospital, South Wollo, Northeast Ethiopia, 2020. A case-control study. PLoS One 2021; 16:e0248490. [PMID: 33724992 PMCID: PMC7963039 DOI: 10.1371/journal.pone.0248490] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/27/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Globally, tuberculosis takes the first rank for the ill-health of people living with HIV/AIDS. Despite the favorable outcome of antiretroviral therapy, the risk of tuberculosis remains higher among HIV patients. This obliges to identify factors for its occurrence and further prevention of drug-resistant tuberculosis. There is a contradiction between different studies and studies conducted in Ethiopia studied poorly the association between adherence to antiretroviral therapy and viral load with tuberculosis. Studies conducted in the study area were limited to cross-sectional study design. Therefore, this study claimed to identify factors determining the occurrence of tuberculosis after initiation of antiretroviral therapy. Methods This study was conducted at Dessie Referral Hospital by using a case-control study design on a sample of 565 with a control: case ratio of 3:1. Participants from controls were selected by systematic random sampling and from cases by consecutive random sampling. The data were collected by interviewing through structured questionnaires and from the medical record. The data were entered into Epi data version 3.1. In the multivariable analysis, variables with a P-value of ≤0.05 were anticipated as independent determinant factors. Result Patients without separate kitchen (AOR: 3.547, 95% CI: 2.137, 5.888), having opportunistic infection (AOR: 3.728, 95% CI: 2.058, 6.753), CD4 count of <350 cells/mm3 (AOR: 3.383, 95% CI: 1.520, 7.528), baseline WHO stage III (AOR: 3.321, 95% CI: 1.688, 6.534) or IV (AOR: 2.900, 95% CI: 1.251, 6.722), don’t taking IPT (AOR: 3.701, 95% CI: 2.228, 6.147) and those who were poorly adherent (AOR: 2.626, 95% CI: 1.272, 5.423) or moderately adherent (AOR: 3.455, 95% CI: 1.885, 6.335) to anti-retroviral therapy were more likely to develop tuberculosis after anti-retroviral therapy initiation. Conclusion Poor housing conditions, having an opportunistic infection, low CD4 count, starting ART at the advanced HIV stage, don’t take IPT, and being poorly adherent to antiretroviral therapy were associated with the occurrence of TB after initiation of ART. The institution should screen for TB as early as possible and strictly follow their drug adherence.
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Affiliation(s)
- Mehd Abdu
- Department of Nursing, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Teferi, Ethiopia
- * E-mail:
| | - Yeshimebet Ali
- Department of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Samuel Anteneh
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mohammed Yesuf
- Department of Nursing, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Adane Birhanu
- Department of Nursing, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Salih Mohamed
- Department of Anesthesia, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Adem Hussien
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Azanaw MM, Derseh NM, Yetemegn GS, Angaw DA. Incidence and predictors of tuberculosis among HIV patients after initiation of antiretroviral treatment in Ethiopia: a systematic review and meta-analysis. Trop Med Health 2021; 49:18. [PMID: 33632342 PMCID: PMC7905193 DOI: 10.1186/s41182-021-00306-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/09/2021] [Indexed: 11/15/2022] Open
Abstract
Background Tuberculosis is the oldest infectious disease and it is still the leading cause of morbidity and mortality worldwide. Even though several primary studies have been conducted on the incidence of tuberculosis among HIV-infected individuals in Ethiopia, national-level tuberculosis incidence is unknown. Therefore, this study is aimed to assess the TB incidence rate and its predictors among HIV-infected individuals after the initiation of ART in Ethiopia. Methods We conducted an extensive search of literature as indicated in the guideline of reporting systematic review and meta-analysis (PRISMA). The databases used were PubMed, Google Scholar, and HINARI literature. We used the Joanna Briggs Institute (JBI) Meta-Analysis of Statistics Assessment and Review Instrument for critical appraisal of studies. The meta-analysis and Meta regressions were conducted using STATA 14 software. Met-analysis and meta-regression were computed to present the pooled incidence rate and predictors of tuberculosis among HIV-infected patients after initiation of ART with a 95% confidence interval. Results Among a total of 189 studies, 11 studies were included in this analysis. The estimated pooled incidence rate of TB per 100-person year observation (PYO) among HIV-infected patients after initiation of ART therapy was 4.8(95% CI 3.69–5.83). In subgroup analysis, the estimated pooled incidence of tuberculosis showed a slight difference between adults and children after initiation of ART treatment, which was 4.3 (95% CI 2.96, 5.71) and 5.0 (95% CI 3.51, 6.50), respectively. Significantly pooled estimates of predictors of TB incidence by a meta-analysis were being anemic (2.30, 95% CI 1.75, 3.02); on clinical stages III and IV (2.26, 95% CI 1.70, 3.02); and not on cotrimoxazole preventive therapy (CPT) (2.16, 95% CI 1.23, 3.72). Besides, a meta-regression revealed that CD4 <200 cells/mm3 (2.12, 95% CI 1.17, 3.86) was a positive significant predictor of TB among HIV patients after the initiation of ART. Conclusions The current study showed that the pooled incidence of TB among HIV patients was found to be lower than the WHO 2018 national estimate. Being anemic, WHO stages III and IV, not on CPT, CD4<200cells/μl, and being male were significant predictors of tuberculosis. Therefore, the existing strategies to decrease TB should be strengthening. Study protocol registration CRD42020155573. Supplementary Information The online version contains supplementary material available at 10.1186/s41182-021-00306-2.
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Affiliation(s)
- Melkalem Mamuye Azanaw
- Department of Social and Public Health, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | | | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
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Kiros T, Dejen E, Tiruneh M, Tiruneh T, Eyayu T, Damtie S, Amogne K. Magnitude and Associated Factors of Pulmonary Tuberculosis Among HIV/AIDS Patients Attending Antiretroviral Therapy Clinic at Debre Tabor Specialized Hospital, Northwest Ethiopia, 2019. HIV AIDS (Auckl) 2020; 12:849-858. [PMID: 33299357 PMCID: PMC7721108 DOI: 10.2147/hiv.s282616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/28/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) has remained as a top global public health concern of the 21st century. It is the leading cause of morbidity and mortality among people living with human immunodeficiency virus (HIV) worldwide. OBJECTIVE The study aimed to investigate the magnitude of pulmonary tuberculosis and its associated factors among HIV-positive patients attending antiretroviral treatment (ART) clinic in Debre Tabor specialized hospital, Northwest, Ethiopia. METHODS A hospital-based cross-sectional study was conducted among 362 HIV-positive adult participants attending the ART clinic from October 1st to December 30th 2019. Socio-demographic data were collected using a pre-tested questionnaire. Sputum was collected aseptically into a sterile and leak-proof container. Following aseptic techniques, each sample was processed using the GeneXpert assay based on the manufacturer's instructions. Similarly, about 3-5 mL of whole blood was drawn for CD4+ T-cell count and plasma viral load tests following standard blood collection procedures. CD4+ T-cell count was performed using the BD FACS caliber flow cytometry while the plasma viral load was performed by using a quantitative real-time polymerase chain reaction. Then, collected data were double-checked, cleaned and entered into Epi-Info version 7.2.0.1 and exported to SPSS version 20.0 for further statistical analysis. The bivariate and multivariate logistic regression were conducted to address risk factor analysis. The 95%confidence interval with its corresponding cure and adjusted odds ratio was computed. Finally, p-value ≤0.05 was considered as a statistically significant association. RESULTS In this study, the overall prevalence of tuberculosis among HIV-positive patients was 18 [(5%), 95% CI: 2.8-7.5]. A high viral load (≥1000 copies/mL) was positively associated [AOR (95% CI: 6.4 (1.6-25.7)), p < 0.001] with developing tuberculosis among HIV-positive patients. CONCLUSION The prevalence of TB is low among ART-receiving patients in our study site.
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Affiliation(s)
- Teklehaimanot Kiros
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Eninur Dejen
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulu Tiruneh
- Department of Social and Public Health, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tegenaw Tiruneh
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tahir Eyayu
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Shewaneh Damtie
- Department of Medical Laboratory Sciences, College of Health Sciences and School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kefyalew Amogne
- Debre Tabor College of Health Sciences, Debre Tabor, Ethiopia
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14
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Wang G, Xu J, Huang B, Gao S, Zhuang Y, Wang K, Zhang Y, Jiang J. Epidemiological characteristics of pulmonary tuberculosis among health-care workers in Henan, China from 2010 to 2017. BMC Infect Dis 2020; 20:484. [PMID: 32640996 PMCID: PMC7346616 DOI: 10.1186/s12879-020-05163-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/17/2020] [Indexed: 11/21/2022] Open
Abstract
Background Health-care workers (HCWs) are an epidemiological group with increased exposure to tuberculosis (TB), especially at health-care facilities (HCFs) with poor TB infection control in high-TB-burden settings. China is a high-TB-burden country, and the comprehensive measures for stopping TB transmission at some HCFs were not implemented well owing to limited resources and other factors. The purpose of this study was to review risk of occupational exposure to TB among HCWs and its change trend, and identify epidemiological characteristics of pulmonary tuberculosis (PTB) among HCWs in Henan, central part of China. Methods A retrospective cohort study was conducted from 2010 to 2017. All HCWs and teachers in Henan were enrolled to the study as exposed group and non-exposed control group, respectively. Relative risk (RR), attributable risk (AR) and AR percent (AR%) were used to measure the association between the occupational exposure and PTB, and estimated with Poisson regression. Results The study results showed a total of 1663 cases of PTB were reported among the HCWs in Henan, accounting for 3.2‰ of all PTB cases reported in the whole population, and annual incidence rate of PTB among HCWs declined by 34% from 2010 to 2017. Over the eight years, the incidence rate of PTB among HCWs was 43.7 cases per 100,000 person-years (PYs), significantly higher than that among teachers (18.8 cases/100,000 PYs), and RR, AR and AR% were estimated to 2.3, 24.9 cases per 100,000 PYs and 57%, respectively. Among HCWs, males were more likely to suffer from PTB than females (adjusted RR: 1.3; 95%CI: 1.2–1.4), and HCWs aged under 25 years had the highest relative risk over all age groups with adjusted RR equaling to 8.3 (95%CI: 6.9-9.9) calculated with those aged 45–54 years as the reference. Conclusions Although overall incidence rate of PTB among HCWs showed decreasing temporal trends over the period of 2010–2017, attributable risk of occupational exposure to TB among HCWs did not decrease in Henan, and TB infection at HCFs for males, young or senior HCWs, especially for young HCWs is of much concern.
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Affiliation(s)
- Guojie Wang
- Medicine Faculty, Henan Medical College, Zhengzhou, Henan, China
| | - Jiying Xu
- Anti-TB Institute, Henan Provincial Centre for Disease Control and Prevention, Zhengzhou, Henan, China.
| | - Bin Huang
- Pharmacy Faculty, Henan Medical College, Zhengzhou, Henan, China
| | - Sanyou Gao
- Anti-TB Institute, Henan Provincial Centre for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Yan Zhuang
- Anti-TB Institute, Henan Provincial Centre for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Kan Wang
- Anti-TB Institute, Henan Provincial Centre for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Yanqiu Zhang
- Anti-TB Institute, Henan Provincial Centre for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Jianguo Jiang
- Anti-TB Institute, Henan Provincial Centre for Disease Control and Prevention, Zhengzhou, Henan, China
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Gebretsadik D, Ahmed N, Kebede E, Mohammed M, Belete MA. Prevalence of Tuberculosis by Automated GeneXpert Rifampicin Assay and Associated Risk Factors Among Presumptive Pulmonary Tuberculosis Patients at Ataye District Hospital, North East Ethiopia. Infect Drug Resist 2020; 13:1507-1516. [PMID: 32547120 PMCID: PMC7247715 DOI: 10.2147/idr.s248059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/29/2020] [Indexed: 01/05/2023] Open
Abstract
Background Tuberculosis is a communicable disease that is a major cause of ill health, one of the top 10 causes of death worldwide, and the leading cause of death from a single infectious agent, even ranking above human immuno-deficiency virus (HIV/AIDS). Objective To assess the prevalence and associated risk factor of Mycobacterium tuberculosis among pulmonary tuberculosis (PTB) suspects attending at Ataye District Hospital from October 1, 2018, to February 30, 2019. Methodology A facility-based cross-sectional study was conducted among 423 presumptive tuberculosis patients at Ataye District Hospital. Sputum was processed by MTB/RIF Xpert assay. Data were entered into EpiData 3.1 software and exported to SPSS version 20.0 (SPSS, Chicago, IL, USA) for analysis. Univariate and multivariate analyses were used to examine the relationship between the dependent and independent variables. Variables that show significance at P-value of 0.3 during univariate analysis were selected for multivariable analysis. A P-value of less than or equal to 0.05 was used to indicate statistical significance. Results Out of the total study participants, about 60% were male, and 39% were aged between 18 and 24 years. Of the total 423 PTB suspected patients, 38 (8.98%) of them were identified as having PTB by GeneXpert and 2/38 (5.3%) were resistant to rifampicin and 3/38 (7.89%) patients were co-infected with HIV. Participant age between 18 and 24 years and between 25 and 34 years, weight loss, chest pain, having contact history with confirmed PTB cases, utilization of congested transportation, and a history of imprisonment were significantly associated with the prevalence of PTB. Conclusion A considerable prevalence of PTB in the area was observed and the magnitude of MDR-TB was low. PTB is still a public health problem in Ethiopia and there is a need for collaborative prevention and control activities in the study area.
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Affiliation(s)
- Daniel Gebretsadik
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Nuru Ahmed
- Ataye District Hospital, Ataye, Ethiopia
| | - Edosa Kebede
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Miftah Mohammed
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Melaku Ashagrie Belete
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Diriba G, Kebede A, Tola HH, Alemu A, Tadesse M, Tesfaye E, Mehamed Z, Meaza A, Yenew B, Molalign H, Dagne B, Sinshaw W, Amare M, Moga S, Abebaw Y, Sied G. Surveillance of drug resistance tuberculosis based on reference laboratory data in Ethiopia. Infect Dis Poverty 2019; 8:54. [PMID: 31200748 PMCID: PMC6567428 DOI: 10.1186/s40249-019-0554-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/22/2019] [Indexed: 11/24/2022] Open
Abstract
Background Both passive and active surveillance of drug resistance have an important role in tuberculosis (TB) control program. Surveillance data are important to estimate the magnitude of drug resistance TB, to know the trend of the disease, assess the performance of the program, and to forecast diagnosis and treatment supplies. Therefore, this study aimed to determine the prevalence and the proportion of drug resistant tuberculosis in Ethiopia based on passively collected data. Methods A cross-sectional study was conducted at the National Tuberculosis Reference Laboratory and seven Regional TB laboratories in Ethiopia on a retrospective data collected from July 2017 to June, 2018. Data were collected by standardized checklist from TB culture laboratory registration book. Percentage of recovery rate, contamination rate, and prevalence of drug resistance TB were determined by Statistical Package for Social Science (SPSS) version 23. Result Of 10 134 TB suspected individuals included into this analysis, 1183 (11.7%) were culture positive. The overall contamination proportion was 5.3% and nontuberculous mycobacteria proportion was 0.98%. First-line drug susceptibility test was performed for 329 Mycobacterium tuberculosis complex isolates, and the proportion of resistance was 5.7 and 6.3% for isoniazid and rifampicin respectively. The proportion of multidrug-resistant tuberculosis (MDR-TB) was 4.3% in new patients, while 6.7% in previously treated patients. However, there was no category for 0.6% patients, and the overall proportion of MDR-TB was 11.6%. Conclusions The result of this study indicated that MDR-TB is a serious public health problem in Ethiopia. Thus, strengthen prevention and control program is vital to halt the burden of drug resistant TB in the country. Electronic supplementary material The online version of this article (10.1186/s40249-019-0554-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Getu Diriba
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
| | - Abebaw Kebede
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Ayinalem Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Zemedu Mehamed
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abiyot Meaza
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bazezew Yenew
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Biniyam Dagne
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Misikir Amare
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Shewki Moga
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Getachew Sied
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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