Feyisa Jira Wakoya, Dufera Mebrate, Feyisa Bikila Regassa, Debelo Sidise, Dori Jibril, Shama Adisu Tafari
School of Public Health, Institute of Health Sciences, Wollega University, Nekemt, P.O. Box: 395, Ethiopia.
Department of Biology, College of Natural and Computational Sciences, Wollega University, Nekemt, Ethiopia.
BMC Public Health. 2025 May 26;25(1):1939. doi: 10.1186/s12889-025-23194-1.
The reoccurrence of Tuberculosis infection is one of the challenging problems in meeting the global Tuberculosis prevention goal. It contributes to morbidity and mortality, economic crisis, spread of infection among the population, and affects health-related quality of life. Despite the public health significance of the problem, there is a paucity of knowledge to well understand the time to reoccurrence of tuberculosis among HIV population and the factors that determine the recurrence of the problem in the context of Ethiopia.
To assess the time to reoccurrence of tuberculosis and its predictors among adult HIV/AIDS patients attending ART clinics at health facilities in East and Horro Guduru wollega zones.
A Hospital-based retrospective follow-up study was conducted among HIV/AIDS patients attending the ART clinic from Jan 1, 2015 to Feb, 30, 2020 by collecting information from the medical records of 442 patients. A sampling frame from the ART log book was prepared. A simple random sampling technique from patient records was employed. The structured checklist was used. Bivariable and multivariable Cox regression with crude hazard ratio and the adjusted hazard ratio, respectively, were used to identify independent predictors for the reoccurrence of Tuberculosis. A P-value of < 0.05 with 95% CI was used to declare significantly associated predictors.
The median survival time of TB reoccurrence in this study was 72 months. Sex (AHR = 4.90 (95%CI:1.98, 12.53), widowed marital status (AHR = 4.00; 95%CI:1.13, 14.14), occupational status (AHR = 3.45;95%CI: 1.12, 10.64), advanced WHO clinical stages (AHR = 6.98; 95%CI: 1.71, 28.45), recurrence of opportunistic infections (AHR = 10.49; 95%CI:2.14, 51.54), low adherence to Anti-TB drugs (AHR = 2.38; 95%CI:1.01, 5.64), facing multidrug resistance during the preceding episode of TB (AHR = 25.06; 95%CI:6.49, 96.66), CD4 count < 200 (AHR = 10.09 95%CI: 3.62, 28.17), and viral load (AHR = 1.01 (95%CI:1.00, 1.02) were significant predictors of TB reoccurrence among HIV patients.
The median survival time among adult HIV patients was higher in the first 80 months of ART initiation and it decreased over the time of ART. Sex, occupational status, marital status, low CD4 count, viral load, advanced WHO clinical stage, reoccurrence of other opportunistic infections, poor adherence to TB treatment, and facing multidrug-resistant TB were independent predictors for reoccurrence of TB among HIV-positive adults.
结核病感染的复发是实现全球结核病预防目标中具有挑战性的问题之一。它会导致发病率和死亡率上升、经济危机、人群中感染的传播，并影响与健康相关的生活质量。尽管该问题具有公共卫生意义，但在埃塞俄比亚的背景下，对于充分了解艾滋病毒感染者中结核病复发的时间以及决定该问题复发的因素，仍缺乏相关知识。
评估在东部和霍罗古杜鲁沃莱加地区卫生设施中接受抗逆转录病毒治疗（ART）门诊的成年艾滋病毒/艾滋病患者中结核病复发的时间及其预测因素。
对2015年1月1日至2020年2月29日期间在ART门诊就诊的艾滋病毒/艾滋病患者进行了一项基于医院的回顾性随访研究，通过收集442例患者的病历信息。从ART日志中编制了抽样框架。采用简单随机抽样技术从患者记录中选取样本。使用结构化检查表。分别采用单变量和多变量Cox回归分析，以粗风险比和调整后的风险比来确定结核病复发的独立预测因素。P值<0.05且95%置信区间用于确定显著相关的预测因素。
本研究中结核病复发的中位生存时间为72个月。性别（调整后风险比[AHR]=4.90，95%置信区间：1.98，12.53）、丧偶婚姻状况（AHR=4.00；95%置信区间：1.13，14.14）、职业状况（AHR=3.45；95%置信区间：1.12，10.64）、世界卫生组织（WHO）临床晚期（AHR=6.98；95%置信区间：1.71，28.45）、机会性感染复发（AHR=10.49；95%置信区间：2.14，51.54）、抗结核药物依从性低（AHR=2.38；95%置信区间：1.01，5.64）、在前次结核病发作期间面临多重耐药（AHR=25.06；95%置信区间：6.49，96.66）、CD4细胞计数<200（AHR=10.09，95%置信区间：3.62，28.17）以及病毒载量（AHR=1.01，95%置信区间：1.00，1.02）是艾滋病毒患者中结核病复发的显著预测因素。
成年艾滋病毒患者在开始抗逆转录病毒治疗的前80个月中位生存时间较高，且随着抗逆转录病毒治疗时间的推移而降低。性别、职业状况、婚姻状况、低CD4细胞计数、病毒载量、WHO临床晚期、其他机会性感染复发、抗结核治疗依从性差以及面临多重耐药结核病是艾滋病毒阳性成年人中结核病复发的独立预测因素。
