Characteristics and treatment outcomes of adolescents and young adults living with HIV with drug-resistant tuberculosis co-infection in Uganda: a retrospective cohort study.

BACKGROUND

Tuberculosis (TB) remains a significant global health challenge, especially among people living with HIV. Drug-resistant TB (DR-TB) complicates treatment outcomes in high-burden countries like Uganda, particularly for adolescents and young adults living with HIV (AYALH).

OBJECTIVES

We described the characteristics, treatment outcomes, and factors associated with treatment success among AYALH and DR-TB at a TB treatment unit in Mulago National Referral Hospital, Kampala, Uganda.

DESIGN

A retrospective cohort study was conducted.

METHODS

Medical records of AYALH treated for DR-TB between January 2013 and December 2021 were reviewed. Descriptive statistics and multivariable logistic regression were used to analyze treatment outcomes and associated factors.

RESULTS

Among 327 participants (mean age: 28.2 years, SD: 4.75; 52.6% male), the treatment success rate was 65.7%. A body mass index (BMI) ⩾ 18.5 kg/m (adjusted odds ratio [aOR]: 0.53, 95% CI: 0.33-0.83,  = 0.005), Efavirenz-based antiretroviral therapy (ART) regimens (aOR: 0.56, 95% CI: 0.35-0.89,  = 0.014), and primary DR-TB (aOR: 0.42, 95% CI: 0.28-0.64,  < 0.001) were significantly associated with treatment success.

CONCLUSION

The study revealed a treatment success in only two-thirds of participants emphasizing persistent challenge of achieving optimal treatment outcomes for AYALH. The findings highlight that a higher BMI and Efavirenz-based ART regimens are significantly associated with improved treatment success pointing to the necessity for addressing nutritional needs and optimizing ART regimens to improve the management of DR-TB among AYALH.