Tuberculosis treatment survival of HIV positive TB patients on directly observed treatment short-course in Southern Ethiopia: A retrospective cohort study

BMC Research Notes

Alemayehu Worku¹  Debebe Shaweno² 

[1] Associate professor of Biostatistics, School of public health, College of Health Sciences Addis Ababa University, P O Box 32812, Addis Ababa, Ethiopia;School of Public and Environmental health, Hawassa University, P.O.Box 1560, Hawassa, Ethiopia

关键词: Health center;    Hawassa;    HIV positive;    TB patients;    Survival;    TB treatment;   

Others  :  1165031
DOI  :  10.1186/1756-0500-5-682

 received in 2012-05-23, accepted in 2012-12-11,  发布年份 2012

【 摘 要 】

Background

Tuberculosis (TB) and HIV co-infection remains a major public health problem. In spite of different initiatives implemented to tackle the disease, many countries have not reached TB control targets. One of the major attributing reasons for this failure is infection with HIV. This study aims to determine the effect of HIV infection on the survival of TB patients.

Findings

A retrospective cohort study was employed to compare the survival between HIV positive and HIV negative TB patients (370 each) during an eight month directly observed treatment short-course (DOTS) period. TB patient’s HIV status was considered as an exposure and follow up time until death was taken as an outcome. All patients with TB treatment outcomes other than death were censored, and death was considered as failure. Cox proportional hazard regression model was used to determine the hazard ratio (HR) of death for each main baseline predictor. TB/HIV co-infected patients were more likely to die; adjusted Hazard Rate (AHR) =1.6, 95%CI (1.01, 2.6) during the DOTS period. This risk was statistically higher among HIV patients during the continuation phase (p=0.0003), as a result HIV positive TB patients had shorter survival (Log rank test= 6.90, df= 2, p= 0.008). The adjusted survival probability was lower in HIV positive TB patients (< 15%) than HIV negative TB patients (> 85%) at the end of the DOTS period (8^th month).

Conclusion

TB treatment survival was substantially lower in HIV infected TB patients, especially during the continuation phase. Targeted and comprehensive management of TB/HIV with a strict follow up should be considered through the entire TB treatment period.

【 授权许可】

   
2012 Shaweno and Worku; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]WHO: Global Tuberculosis Control: Epidemiology, Strategy, Financing: WHO Report 2009. Switzerland: Epidemiology, Strategy, Financing Geneva; 2009.
• [2]World TB Day: UN Secretary-General's message on the occasion of World TB Day. 2009. accessed from http://www.safaids.org.zw webcite on 4/9/2009
• [3]TB Still World's Number Two Killer: Inter Press Service. 2009. accessed from http://www.ips.org webcite on 9/9/2009
• [4]WHO: Promoting the implementation of collaborative TB/HIV activities through public-private mix and partnerships: Report of a WHO consultation. Geneva, Switzerland: Acta Palaeontologica Polonica; 2008:27-28.
• [5]Federal Ministry of Health of Ethiopia: Manual of Tuberculosis, Leprosy and TB/HIV prevention and control programme. 4th edition. Addis Ababa, Ethiopia: Ministry of Health of Ethiopia; 2008.
• [6]Federal Ministry of Health of Ethiopia: Tuberculosis prevention and control program, special issue for world TB day. Annual Bulletin 2009, 1(1):5-35.
• [7]WHO: TB/HIV: A clinical Manual: Stop TB Department, Department of HIV/AIDS, Department of Child and Adolescent Health and Development. Second edition edition. Geneva: World Health Organization; 2004.
• [8]Mahajan V, Verma SK: HIV-Tuberculosis co-infection. The Internet Journal of Pulmonary Medicine 2008. accessed from: http://www.ispub.com webcite on 21/8/2009
• [9]USAID: Tuberculosis Profile in Ethiopia. 2009. Accessed from www.usaid.gov webcite on 21/8/2009
• [10]WHO: Global Tuberculosis Control Report. Geneva, Switzerland: WHO; 2008.
• [11]Columbia University Mailman School of Public Health: Screening for Tuberculosis in Individuals with HIV Infection. A Clinical Guide for HIV Care Providers in Resource-limited Settings. USA: International Center for AIDS Care and Treatment Programs; 2007.
• [12]Sarder N, Hossain S, Huda M, Eunus A, Rahman M: Consequence on treatment of TB patients affected by HIV/AIDS :a conceptual research. Am J Infect Dis 2006, 2(4):210-218.
• [13]Estifanos BS: Trends, challenges and opportunities in tuberculosis control in rural Ethiopia: Epidemiological and operational studies in a resource-constrained setting. Unpublished thesis for the degree Philosophiae Doctor (PhD). Norway: University of Bergen; 2006.
• [14]Tuberculosis Deaths among Populations with High HIV Prevalence: Working paper contributed to the Scientific Working Group on Tuberculosis Research, Special Programme for Research and Training in Tropical Diseases: Stop TB Department, World Health Organization. 2009. Accessed from http://www.who.int/tdr/publications/publications/swg_tub.htm webcite on 9/9/2009
• [15]Moolphate S, Aung MN, Nampaisan O, Nedsuwan S, Kantipong P, Suriyon N, Chamnarn H, Yanai H, Yamada N: Time of highest tuberculosis death risk and associated factors: an observation of 12 years in Northern Thailand. International Journal of General Medicine 2011, 4:181-190.
• [16]Daniel OJ, Alausa OK: Treatment outcome of TB/HIV positive and TB/HIV negative patients on directly observed treatment, short course (DOTS) in Sagamu, Nigeria. Niger J Med 2006, 15(3):222-226.
• [17]El-Sony AI, Khamis AH, Enarson DA, Baraka O, Mustafa SA, Bjune G: Treatment results of DOTS in 1797 Sudanese tuberculosis patients with or without HIV co-infection. Int J Tuberc Lung Dis 2002, 6(12):1058-1066.
• [18]WHO, USAIDGHANA: Guidelines for the Clinical Management of TB and HIV Co-infection in Ghana. Ghana Health service; 2007.
• [19]MEDECINS SANS FRONTIERES: Tuberculosis: Practical guide for clinicians, nurses, laboratory technicians and medical auxiliaries. 5th edition. Paris: Medecins Sans Frontieres; 2008.
• [20]Granich R, Mermim J: HIV Health & Your Community: A Guide for Action. USA: Hesperian Foundation; 1999.
• [21]PARDESHI G: Survival analysis and risk factors for death in tuberculosis patients on directly observed treatment-short course. Indian J Med Sci 2009, 63(5):181-186.
• [22]Vasantha M, Gopi P, Subramani R: Survival of tuberculosis patients treated under DOTS in a rural tuberculosis unit. South India. Indian J Tuberc 2008, 55:64-69.