INCIDENCE AND PREDICTORS OF TUBERCULOSIS AMONG ADULT PATIENTS ENROLLED IN THE UNIVERSAL TEST AND TREAT PROGRAM OF HIV CARE AT PUBLIC HEALTH FACILITIES IN GAMO ZONE, SOUTHERN ETHIOPIA: 2020

Abstract

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Introduction: Ethiopia is one of 20 countries with a high burden (who share 84% of global incidence) of TB and TB/HIV for 2015-2020. Universal test and treat modality is implemented since 2017 that is expected to reduce mortality due to opportunistic infections. Therefore, determining the current incidence of tuberculosis and identifying its predictors accordingly is crucial for programming and designing evidence-based decision making. The study aimed to assess incidence and predictors of tuberculosis infection among adult patients on HIV care in Public health facilities in Gamo zone, from January, 2017- March, 2020 GC. Method: Health facility-based retrospective follow up study was conducted among randomly selected 393 newly enrolled adults to antiretroviral service at public health facilities in Gamo zone from January, 2017 to March, 2020. Data was collected using a structured data extraction tool, entered into Epi-data version 4.2.2.1 and exported to Stata version 14 for analysis. The incidence rate of tuberculosis was calculated. Kaplan-Meier curve and Log- rank test was used to describe and to compare time-to-event across the different categories. Cox proportional hazards model fitted and in the multivariable analysis, Adjusted Hazard Ratio with 95% CI computed, and association with P < 0.05 considered Significant. Result: Cumulative incidence of tuberculosis was 66 per thousand adults in HIV care and the overall incidence density of TB was 4.51 per 100 person-year of observation. Baseline CD4 200cells/µl or less, adjusted hazard ratio (AHR: 2.91, 95% CI: 1.21, 6.99), body mass index (BMI) <18.5 kg/m2 (AHR: 2.93, 95 % CI: 1.28, 6.72), and not taking 6 month full course isoniazid preventive therapy (AHR: 9.52, 95 % CI: 3.87, 23.40), were significant predictors for the incidence of TB. Conclusion and recommendation: The overall incidence rate of TB among adult patients on HIV care in this study was 4.51 per 100 person years of observation. The predictors for TB incidence in adult patients on HAART were Underweight status (BMI <18.5 kg/m2 ), baseline CD4 level below 200cells/µl, and not taking full dose isoniazide preventive therapy for 6 months. Special follow up care should be given to those patients with lower CD4 count and underweight. Assuring that all candidate clients were getting Isoniazide preventive