Incidence and Predictors of Tuberculosis among Adult People Living With Hiv At Tarcha General Hospital, Dawuro, Southwest Ethiopia2023: A Retrospective Cohort Study Using Survival Analysis.

Abstract

Background: Tuberculosis (TB) is the most frequently diagnosed oportunistic infection among people living with human immunodeficiency virus (PLHIV). It remains one of the world’s leading causes of mortality among PLHIV. Despite the provision of ART and other medication that is used to prevent opportunistic infection, the incidence of TB among HIV patients remains high. Objective: To assess the incidence and predictors of Tuberculosis among adult people living with HIV at Tarcha general hospital, Dawuro, Southwest Ethiopia, 2023. Method: An institution-based retrospective cohort study was conducted among 318 randomly selected adult HIV patients who initiated antiretroviral therapy at Tarcha General hospital between December 2018 - January 2022. Simple random sampling techinque was used to select the study populations. The checklist was compiled in English was used to extract the data. Two ART-trained nurses who worked in the Tarha General Hospital ART clinic gathered the data. The data were entered into Epi Data version 4.6 and then exported and analyzed by STATA version 14. Kaplan Meier survival estimate was used to show the over all survival probability of patient living with HIV (human immunodeficiency virus). Variables with p-values ≤ 0.25 in bivariable analysis will be taken to multivariable cox regression. On a multi variable cox regression analysis, variables with a P-value ≤ 0.05 will be declared as statistically significant factors associated with outcome variables and reported with adjusted hazard ratio along with 95% confidence interval. Result: - A total of 318 HIV-positive adults were included in the study, of whom 46(14.5%) developed TB at the same time of the follow-up period. This study found that the incidence of TB was 13.6 (95% CI: 12.36-8.28) per 100 person-year of observation. The median survival time was 30 months (IQR: 21.96 - 39.96). Patients who have not updated family matrix (AHR 2.85, 95% CI: 2.23-6.61), Patients with ambulatory status ( AHR 5.23, CI 95%: 2.07-13.8), base line OIS status (AHR,3.3 CI 95% 1.02-10.65), Baseline BMI less than 18kg/m2 (AHR: 4.63 95% CI, 1.68 13.24), WHO stage IV (AHR, 4.55, CI 95%: 1.26-16.29), baseline Hgb less than 10mg/dl (AHR 5.94, CI 95%: 2.23-15.81), OIS after HAART started (AHR, 3.26 CI 95%: 1.24-7.45) and patients who did not completed IPT (AHR, 3.32 CI 95%: 1.08 -10.8) were found to be the predictors of tuberculosis. Conclusion: - The incidence of TB among PLHIV was higher in this study. Not updating the family matrix, advanced WHO stage, low Hgb, and BMI, not completing IPT, and OIS after HAART initiation were found to be the significant predictors of TB. Therefore, health workers and iii other stakeholders are encouraged to made early screening and prevention of TB in PLHIV as TB can occur in any course of HIV treatment.