Shah Gulzar Hussain, Ewetola Raimi, Etheredge Gina, Maluantesa Lievain, Waterfield Kristie, Engetele Elodie, Kilundu Apolinaire
Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro/Savannah, GA 30460, USA.
Division of Global HIV and Tuberculosis, CDC, Atlanta, GA 30333, USA.
Int J Environ Res Public Health. 2021 May 13;18(10):5165. doi: 10.3390/ijerph18105165.
(1) Background: In resource-limited countries, patients with tuberculosis (TB)/HIV coinfection commonly face economic, sociocultural, and behavioral barriers to effective treatment. These barriers manifest from low treatment literacy, poverty, gender inequality, malnutrition, societal stigmas regarding HIV, and an absence of available care. It is critical for intervention programs to understand and assist in overcoming these barriers and any additional risks encountered by patients with TB/HIV coinfection. This study analyzes variation in TB/HIV coinfection and risks of negative outcomes among patients with TB/HIV coinfection compared to those without coinfection. (2) Methods: This quantitative study used data from 49,460 patients receiving ART from 241 HIV/AIDS clinics in Haut-Katanga and Kinshasa, two provinces in the Democratic Republic of Congo. Chi-square and logistic regression analysis were performed. (3) Results: Significantly higher proportions of patients with TB/HIV coinfection were men (4.5%; women, 3.3%), were new patients (3.7%; transferred-in, 1.6%), resided in the Kinshasa province (4.0%; Haut-Katanga, 2.7%), and were in an urban health zone (3.9%) or semi-rural health zone (3.1%; rural, 1.2%). Logistic regression analysis showed that after controlling for demographic and clinical variables, TB/HIV coinfection increased the risk of death (adjusted odds ratio (AOR), 2.26 (95% confidence interval (CI): 1.94-2.64)) and LTFU (AOR, 2.06 (95% CI: 1.82-2.34)). TB/HIV coinfection decreased the odds of viral load suppression (AOR, 0.58 (95% CI: 0.46-0.74)). (4) Conclusions: TB/HIV coinfection raises the risk of negative outcomes such as death, LTFU, and lack of viral load suppression. Our findings can help HIV clinics in Democratic Republic of Congo and other African countries to customize their interventions to improve HIV care and reduce care disparities among patients.
(1) 背景：在资源有限的国家，结核病（TB）/艾滋病病毒（HIV）合并感染的患者在接受有效治疗时通常面临经济、社会文化和行为方面的障碍。这些障碍表现为治疗知识水平低、贫困、性别不平等、营养不良、对艾滋病病毒的社会污名以及缺乏可用的护理。对于干预项目来说，了解并协助克服这些障碍以及TB/HIV合并感染患者遇到的任何其他风险至关重要。本研究分析了TB/HIV合并感染患者与未合并感染患者相比，TB/HIV合并感染情况及不良结局风险的差异。(2) 方法：这项定量研究使用了来自刚果民主共和国两个省份上加丹加省和金沙萨省241家艾滋病毒/艾滋病诊所的49460名接受抗逆转录病毒治疗（ART）患者的数据。进行了卡方检验和逻辑回归分析。(3) 结果：TB/HIV合并感染患者中男性比例显著更高（4.5%；女性为3.3%），新患者比例更高（3.7%；转入患者为1.6%），居住在金沙萨省的比例更高（4.0%；上加丹加省为2.7%），且处于城市卫生区（3.9%）或半农村卫生区（3.1%；农村为1.2%）。逻辑回归分析表明，在控制了人口统计学和临床变量后，TB/HIV合并感染增加了死亡风险（调整后的优势比（AOR）为2.26（95%置信区间（CI）：1.94 - 2.64））和失访风险（AOR为2.06（95%CI：1.82 - 2.34））。TB/HIV合并感染降低了病毒载量抑制的几率（AOR为0.58（95%CI：0.46 - 0.74））。(4) 结论：TB/HIV合并感染增加了死亡、失访和病毒载量未得到抑制等不良结局的风险。我们的研究结果可以帮助刚果民主共和国和其他非洲国家的艾滋病毒诊所定制干预措施，以改善艾滋病毒护理并减少患者之间的护理差距。
