INCIDENCE AND PREDICTORS OF TUBERCULOSIS AMONG ADULT PEOPLE LIVING WITH HIV AT PUBLIC HEALTH FACILITIES OF HAWASSA CITY, SOUTH ETHIOPIA. RETROSPECTIVE FOLLOW UP STUDY By: -

Abstract

Introduction: Tuberculosis is still the leading causes of morbidity and mortality of people living with HIV (PLWHIV). Many of these deaths occur in developing countries, like African. Ethiopia is one of the highly affected Countries by TB/HIV co-infection epidemics. There are few studies done on incidence and predictors TB among PLWHIV and particularly no the same study done in the study area. Objective: The purpose of this study was to assess the incidence and predictors of TB among People living with HIV who were on chronic HIV care services at public health facilities of Hawassa city. Methods: Six years retrospective follow up study was conducted among 554 adult patient s, who were enrolled to chronic HIV care clinic from September 1, 2009 to August 31, 2010 and followed them until August 31, 2015.All samples were taken from the above selected enrollment period who fulfilled inclusion criteria. The data was entered into EPI-ENFO version 7 then exported to SPSS version 20 for analysis. Life table was used to estimate TB free survival, the Kaplan-Meier curve (an intuitive graphical presentation which describes survivorship of the study population) was used to estimate the median duration of TB occurrence and log rank test to compare TB survival curve between the different categories of explanatory variables bivariate and multivariate cox proportional hazards model will used to identify predictors. Results: Out of the 743 charts reviewed, 554 patient records were included in the analysis. The median follow up period was 49.5 months [IQR=10-63 months]. The total follow-up period was 1830.33Person Years (PY). A total of 161 new TB cases were observed during the follow up period. Hence, the overall incidence rate of TB was 8.79 per 100 PY. The commutative proportions of TB survival were 79%, 71% and 67% at the end of one, four and six years, respectively. Not having formal education(AHR=2.68, 95%CI: 1.41, 5.11 ), base line WHO clinical stage IV (AHR = 3.22, 95% CI=1.91-5.41), CD4 count <50 cell/ul (AHR=2.41, 95%CI=1.31, 4.42), ambulatory or bed redden functional status (AHR= 2.89, 95%CI=1.72, 3.78), past TB history (AHR=1.65, 95% CI = 1.06,2.39) substance used patients (AHR=1.46, 95% CI=1.03,2.06) and enrolment status (being on pre ART/ART)(AHR=1.62, 95%CI:1.03-2.54 ) were independent predictors of tuberculosis occurrence. Conclusion: Advanced WHO clinical stage (stage IV), limited functional status, past TB history addiction and low CD4 (<50cell/ul) count at enrollment were found to be the independent predictor of tuberculosis occurrence. Strengthen the transparency & awareness in the community improves early screening and initiation of HAART, so as to maintain CD4 count and functional status in normal range at the enrollment.