Odume B, Pathmanathan I, Pals S, Dokubo K, Onotu D, Obinna O, Anand D, Okuma J, Okpokoro E, Dutt S, Ekong E, Chukwurah N, Dakum P, Tomlinson H
Division of Global HIV and TB, US Centers for Disease Control and Prevention, Nigeria.
Division of Global HIV and TB, US Centers for Disease Control and Prevention, USA.
Univers J Public Health. 2017;5(5):248-255. doi: 10.13189/ujph.2017.050507.
Nigeria has a high burden of HIV and tuberculosis (TB). To reduce TB-associated morbidity and mortality, the World Health Organization recommends that HIV-positive TB patients receive antiretroviral therapy (ART) within eight weeks of TB treatment initiation, or within two weeks if profoundly immunosuppressed (CD4<50 cell/μL).
TB and HIV clinical records from facilities in two Nigerian states between October 1, 2012 and September 30, 2013 were retrospectively reviewed to assess uptake and timing of ART initiation among HIV-positive TB patients. Healthcare workers were qualitatively interviewed to assess TB/HIV knowledge and barriers to timely ART.
Data were abstracted from 4,810 TB patient records, of which 1,249 (26.0%) had HIV-positive or unknown HIV status documented, and the 574 (45.9%) HIV-positive TB patients were evaluated for timing of ART uptake relative to TB treatment. Among 484 (84.3%) HIV-positive TB patients not already on ART, 256 (52.9%, 95% CI: 45.0-60.8) were not initiated on ART during six months of TB treatment. 30.0% of 273 patients with a known CD4≥50cells/μL started ART within eight weeks, and 14.8% of 54 patients with a known CD4<50cells/μL started within the recommended two weeks. Only 42% of health workers interviewed reported knowing to interpret guidelines on when to initiate ART in HIV-positive TB patients based on CD4 cell count results. CD4 cell count significantly predicted timely ART uptake.
A large proportion of HIV-positive TB patients were not initiated on ART early or even at all during TB treatment. Retraining of staff, and interventions to strengthen referral systems should be implemented to ensure timely provision of ART among HIV-positive TB patients in Nigeria.
尼日利亚的艾滋病毒和结核病负担沉重。为降低与结核病相关的发病率和死亡率，世界卫生组织建议，艾滋病毒阳性的结核病患者应在开始结核病治疗后的八周内接受抗逆转录病毒治疗（ART），如果免疫功能严重低下（CD4<50细胞/μL），则应在两周内接受治疗。
回顾性分析2012年10月1日至2013年9月30日期间尼日利亚两个州医疗机构的结核病和艾滋病毒临床记录，以评估艾滋病毒阳性结核病患者接受抗逆转录病毒治疗的情况和开始治疗的时间。对医护人员进行定性访谈，以评估他们对结核病/艾滋病毒的了解以及及时开展抗逆转录病毒治疗的障碍。
从4810份结核病患者记录中提取数据，其中1249份（26.0%）记录了艾滋病毒阳性或艾滋病毒感染状况不明，对574名（45.9%）艾滋病毒阳性的结核病患者评估了相对于结核病治疗开始抗逆转录病毒治疗的时间。在484名（84.3%）尚未接受抗逆转录病毒治疗的艾滋病毒阳性结核病患者中，256名（52.9%，95%CI：45.0-60.8）在结核病治疗的六个月内未开始接受抗逆转录病毒治疗。在273名已知CD4≥50细胞/μL的患者中，30.0%在八周内开始接受抗逆转录病毒治疗，在54名已知CD4<50细胞/μL的患者中，14.8%在推荐的两周内开始接受治疗。在接受访谈的医护人员中，只有42%报告知道应根据CD4细胞计数结果解读关于艾滋病毒阳性结核病患者何时开始抗逆转录病毒治疗的指南。CD4细胞计数显著预测了及时接受抗逆转录病毒治疗的情况。
很大一部分艾滋病毒阳性的结核病患者在结核病治疗期间没有尽早甚至根本没有开始接受抗逆转录病毒治疗。应重新培训工作人员，并实施加强转诊系统的干预措施，以确保尼日利亚的艾滋病毒阳性结核病患者能够及时获得抗逆转录病毒治疗。
