Incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia: A retrospective record review
Abstract Background: Tuberculosis (TB) is the leading cause of morbidity and mortality among people living with human immunodeficiency virus. Almost one-third of deaths among people living with human immunodeficiency virus (PLHIV) are attributed to tuberculosis. Despite this fact, in Ethiopia, particularly in our study area there is a scarcity of information regarding the incidence and predictors of TB among people living with HIV. Thus, this study aimed to assess the incidence and predictors of tuberculosis among HIV-positive adults on antiretroviral therapy (ART). Methods: A retrospective record review was conducted among 544 HIV-positive adults on ART at Debre Markos Referral Hospital from January 1, 2012 to December 31, 2017. The study participants were selected using a simple random sampling technique. The data extraction format was adapted from ART intake and follow-up forms. Cox-proportional hazards regression model was fitted and Cox-Snell residual test was used to assess the goodness of fit. Model with the least value of Akaike’s information criteria was selected as the best model. Tuberculosis free survival time was estimated using the Kaplan-Meier survival curve. Both the bi-variable and multivariable Cox-proportional hazard regression models were used to identify predictors of TB. Results: Among 492 HIV-positive adults included in the final analysis, 16.9% developed TB at the time of follow-up. The incidence rate of TB was found to be 6.5 (95%CI: 5.2, 8.0) per 100-person-years of observation. Advanced WHO clinical disease stage (III and IV) (AHR: 2.1, 95% CI: 1.2, 3.2), being ambulatory and bedridden (AHR: 1.8, 95% CI: 1.1, 3.1), baseline opportunistic infections (AHR: 2.8, 95% CI: 1.7, 4.4), low hemoglobin level (AHR: 3.5, 95% CI: 2.1, 5.8), and not taking IPT (AHR: 3.9, 95% CI: 1.9, 7.6) were found to be the predictors of TB. Conclusion: The study found that there was a high rate of TB occurrence as compared to previous studies. Baseline opportunistic infections, being ambulatory and bedridden, advanced disease stage, low hemoglobin level, and not taking IPT were found to be the predictors of TB. Therefore, early detection and treatment of opportunistic infections like TB should get a special attention. Keywords: Debre Markos, HIV, Incidence, Predictors, TB