Clinical and Psychosocial Determinants of Patients with Tuberculosis/Human Immunodeficiency Virus Co-Infection

Abstract

Background: Tuberculosis (TB)/human immunodeficiency virus (HIV) co-infection is a complex mesh of physical and psychosocial disorders that require a multimodal and multifaceted approach for improved outcomes. Aims: This study determined the treatment outcomes of patients with TB/HIV co-infection and the clinico-psychosocial predictors of the disease over a 10-year period in resource-limited settings. Patients and Methods: This study reviewed the 10-year retrospective treatment outcomes of patients with TB/HIV co-infection in a tertiary centre. The data were retrieved from the TB treatment registers and analyzed with STATA 16.0. The effects of latent constructs of high clinical severity, stigmatization, and family stress/burden on treatment outcomes were evaluated using a structural equation model. Results: Of the 1,321 who met the inclusion criteria, 1,193 had sufficient data. The mean age of the patients was 38.2 ± 16.7 years. The treatment adherence rate over the 10 years was 93.8% (±6.8%) but successful treatment outcome was 75.5% (±8.1%). Stigmatism of TB/HIV infections was experienced by adults and males ( = 0.972; P < 0.001 = 0.674; P < 0.001, = - 0.770; P < 0.001, respectively), non-adherent to treatment ( = -0.460; P < 0.001) clinical severity of illness ( = 0.940; P < 0.001), and being HIV negative ( = -0.770; P < 0.001). Family Stress/Burden was strongly affected by both Death ( = 1.000; P < 0.001) and higher Stigmatism ( = 0.602; P < 0.001). Clinical severity of illness significantly influenced both Death and Unsatisfactory outcomes ( = 0.207; P < 0.001, = 0.203; P < 0.05, respectively). Non-Adherence led to potentially unsatisfactory outcome. Conclusion: TB/HIV co-infection is a complex psychosocial disorder that is significantly and negatively impacted by social determinants of the disease. A holistic approach to treatment intervention that addresses the latent factors of stigmatization, family stress/burden, and high clinical severity is key to achieving a successful treatment outcome.

Stigma and Associated Sex Disparities Among Patients with Tuberculosis in Uganda: A Cross-Sectional Study

“…Two studies conducted in Ethiopia found HIV status linked to increased odds of reporting perceived stigma among patients with TB [ 26 , 46 ]. Additional studies indicate similar findings [ 47 ] as well as a relationship between HIV status and overall stigma in patients with TB[ 48 ]. Syndemic stigma is likely underlying what we observed in our study, where two simultaneously occurring HIV and TB epidemics with their related stigmas are intertwined [ 37 ].…”

The Burden of Bacteriologically Negative TB Diagnosis: A Four-Year Review of Tuberculosis Cases at a Tertiary Facility

“…Delays in establishing the diagnosis of TB in the absence of bacteriological support and other supportive investigations could partly explain the high mortality in this study. Other important factors that contribute to death among HIV patients but not addressed by this study include lack of adherence to ART and TB treatment as well as the duration of symptoms prior to presentation [44][45][46].…”

Trends of Xpert MTB/RIF in the diagnosis of Mycobacterium tuberculosis and rifampicin resistance in Southwest Nigeria: A 4-year retrospective study

“…[2,9] Undernutrition, diabetes, smoking, harmful alcohol consumption, poor treatment adherence to anti-TB drugs; previous haphazard or poor implementation of isoniazid prophylaxis and previous ineffective TB treatment, especially in private practice; increasing treatment failure and loss to follow-up, poor Xpert MTB/RIF diagnostic coverage; and a high burden of human immunodeficiency virus (HIV) coinfection in low-resource settings, including Nigeria, are potential drivers for the high prevalence of resistant TB. [13][14][15][16][17][18][19][20][21][22] Higher prevalence of social determinants such as poverty, inequality, unsafe housing, discrimination, and social stigma in low-resource settings such as Nigeria also plays a significant role in the spread of DR-TB. [13,14,20] According to the 2019 WHO global TB report, Nigeria has one of the highest burdens of MDR/RR-TB, accounting for 4.2% of new cases and 15% of previously treated MTB.…”

“…[13][14][15][16][17][18][19][20][21][22] Higher prevalence of social determinants such as poverty, inequality, unsafe housing, discrimination, and social stigma in low-resource settings such as Nigeria also plays a significant role in the spread of DR-TB. [13,14,20] According to the 2019 WHO global TB report, Nigeria has one of the highest burdens of MDR/RR-TB, accounting for 4.2% of new cases and 15% of previously treated MTB. [2] The reported figure is comparable to those from South Africa, but higher than the regional average and lower than Somalia's notification rate of 8.7% from new cases.…”