Outcomes of TB treatment in HIV co-infected TB patients in Ethiopia: a cross-sectional analytic study

Abstract

Abstract

Background TB and HIV are the most prevalent communicable diseases of major public health importance in the populations of sub-Saharan African countries, and an estimated 30 % of HIV infected persons have dual infection with TB. TB is the leading cause of death in HIV infected individuals, and HIV co-infected TB patients have multiple individual, disease specific and treatment related factors that can adversely affect their treatment outcomes. There is lack of evidence on the individual patient outcomes of HIV co-infected TB patients who receive anti-TB treatment. It is relevant to understand the differential patient outcomes of HIV co-infected TB patients and identify the factors that are associated with these outcomes.

Methods A comparative analysis was done on the data from a random sample of 575 TB patients who were enrolled for TB treatment from January 2013 to December 2013 at eight health facilities in Ethiopia. A descriptive analysis was done on the data, and chi-square test and logistic regression analysis was conducted to compare TB treatment outcomes based on HIV status and to identify factors associated with these outcomes.

Results Out of a total of 575 TB patients enrolled into the study, 360 (62.6 %) were non-HIV infected, 169 (29.4 %) were HIV co-infected, and 46 (8 %) had no documented HIV status. The overall treatment success rate was 91.5 % for all the study participants. HIV co-infected TB patients have a treatment success rate of 88.2 % compared with 93.6 % for non-HIV infected study participants (P = 0.03). HIV co-infected TB patients had a significantly higher rate (11.8 % versus 6.4 %, P = 0.03) of unfavourable outcomes. The cure rate was significantly lower (10.1 % versus 24.2 %, P = 0.001) and the death rate higher in HIV co-infected TB patients (8.3 % versus 2.5 %, P = 0.014). Age and TB classification were significantly associated with treatment outcome. No association was found with starting ART, Cotrimoxazole prophylactic treatment or enrolment in HIV care.

Conclusions There is high TB treatment success rate among patients who have been treated for TB, but the treatment success rate and the cure rate in HIV co-infected TB patients is lower than that observed in non-HIV infected patients. Patients with advanced age and those with smear positive pulmonary TB have unfavourable treatment outcomes.