Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
PLoS One. 2022 Aug 3;17(8):e0272358. doi: 10.1371/journal.pone.0272358. eCollection 2022.
Tuberculosis (TB) is the leading killer of people living with HIV (PLHIV) and almost one-third of deaths in the world are attributed to it and many of these deaths occur in developing countries. Despite these evidences, after the implementation of universal test and treat (UTT) strategy, information regarding the incidence and predictors of tuberculosis among PLHIV is limited in Ethiopia. Therefore, this study aimed to assess the incidence and predictors of tuberculosis among patients enrolled in Anti-Retroviral Therapy (ART) after universal test and treat program at St. Peter hospital and Zewditu Memorial Hospital, Addis Ababa, Ethiopia.
Institutional-based retrospective cohort study was conducted from November 1 to 30, 2020. Simple random sampling was used to select a total of 539 adults records which was enrolled on ART. Data was collected and entered into EPI DATA 3.1 and analyzed using STATA version 14.1. Time-to-event distributions were estimated using Kaplan-Meier estimates. Hazards across different categories were compared using log-rank tests. Predictors were identified using the Cox proportional hazards model. The hazard ratio (HR) and 95% confidence interval (CI) were computed. Variables having P-value < 0.05 from the multivariable analysis were considered as a statistically significant.
Among 539 records reviewed, 529 (98%) were included in the final analysis. The total follow-up period was 1529 Person-Year (PY). The incidence rate in this cohort was found to be 4.84 per 100-person year (95%CI,3.83-6.11). CD4 count<200 (AHR: 3.14,95% CI:1.64-7.10), poor adherence (AHR:2.16, 95% CI:1.21-3.85), underweight (AHR:2.42, 95% CI: 1.30-4.51), not taking isoniazid prophylaxis therapy (AHR: 2.78,95% CI: 1.06-7.30), being bedridden 3.06; (AHR: 3.06, 95% CI: 1.50-6.24), and baseline WHO stage three or four (AHR:2.33, 95% CI:1.08-5.02) were independent predictors for the incidence of TB among HIV positive patients.
In this study, the incidence of tuberculosis is relatively low as compared to studies done before the initiation of test and treat program in Ethiopia. low CD4count, poor level of adherence, low BMI, not taking IPT prophylaxis, bedridden functional status, and being on baseline WHO stage III or IV were found to increase the hazard of tuberculosis. Hence, close follow up, reminders, surveillance, and tracing mechanisms targeting this higher risk group would decrease Tuberculosis among PLHIV.
结核病（TB）是导致艾滋病毒感染者（PLHIV）死亡的主要原因，全球近三分之一的死亡归因于结核病，其中许多死亡发生在发展中国家。尽管有这些证据，但在实施普遍检测和治疗（UTT）策略后，埃塞俄比亚关于 PLHIV 中结核病的发病率和预测因素的信息有限。因此，本研究旨在评估在埃塞俄比亚圣彼得医院和泽维图纪念医院实施普遍检测和治疗方案后接受抗逆转录病毒治疗（ART）的患者中结核病的发病率和预测因素。
这是一项于 2020 年 11 月 1 日至 30 日在埃塞俄比亚亚的斯亚贝巴圣彼得医院和泽维图纪念医院进行的基于机构的回顾性队列研究。采用简单随机抽样选择了总共 539 名接受 ART 的成年患者记录。数据收集并输入 EPI DATA 3.1 并使用 STATA 版本 14.1 进行分析。使用 Kaplan-Meier 估计来估计时间事件分布。使用对数秩检验比较不同类别的风险。使用 Cox 比例风险模型确定预测因素。计算风险比（HR）和 95%置信区间（CI）。多变量分析中 P 值<0.05 的变量被认为具有统计学意义。
在审查的 539 份记录中，有 529 份（98%）被纳入最终分析。总随访期为 1529 人年（PY）。该队列的发病率为 4.84 例/100 人年（95%CI，3.83-6.11）。CD4 计数<200（AHR：3.14，95%CI：1.64-7.10）、依从性差（AHR：2.16，95%CI：1.21-3.85）、体重过轻（AHR：2.42，95%CI：1.30-4.51）、未服用异烟肼预防治疗（AHR：2.78，95%CI：1.06-7.30）、卧床不起 3.06（AHR：3.06，95%CI：1.50-6.24）和基线世卫组织 III 或 IV 期（AHR：2.33，95%CI：1.08-5.02）是 HIV 阳性患者结核病发病的独立预测因素。
与埃塞俄比亚启动检测和治疗方案之前的研究相比，本研究中结核病的发病率相对较低。低 CD4 计数、低依从性水平、低 BMI、未服用 IPT 预防治疗、卧床不起的功能状态以及基线世卫组织 III 或 IV 期被发现会增加结核病的发病风险。因此，针对这一高风险群体，密切随访、提醒、监测和追踪机制将减少 PLHIV 中的结核病。
