Does being on TB treatment predict a higher burden of problems and concerns among HIV outpatients in Kenya? a cross-sectional self-report study

Abstract

Tuberculosis illness is associated with uncertain outcomes, and has high prevalence among people living with HIV. The new World Health Organization's End TB strategy specifies person-centred symptom management and psychosocial support alongside treatment within its pillars and components. There is a paucity of research to inform an effective care response in Kenya in terms of self-reported outcomes. We aimed to measure the three day period intensity of problems and concerns (physical, psychological, social and spiritual), and identify predictors of problems and concerns, among HIV patients attending outpatient care. We conducted a cross-sectional self-report quantitative study among adult (aged at least 18 years) patients with confirmed HIV diagnosis, and aware of their diagnosis and attending HIV outpatient care in Kenya. Multi-dimensional palliative care problems and concerns were collected using African Palliative Outcome Scale (APOS). Ordinal logistic regression assessed the association of multi-dimensional problems and concerns controlling for demographic variables (age, gender, education and wealth) and clinical variables (WHO clinical stage, HIV treatment status, TB treatment status, and CD4 count). We recruited N = 400 participants. N = 61 (15.64%) were on TB treatment. The items with worst score responses were help and advice to plan for the future (52.5%), ability to share feelings (46.25%), at peace (30.75%) pain (27%) and life worthwhile (18.75%). TB treatment status was associated with lower (worse) score for APOS total score (odds ratio .59, 95% CI .36 to .99; P = 0.046) and factor 3(existential and spiritual wellbeing: .55, .32 to .92; p = 0.023). Interestingly higher CD4 count was predictive of lower (worse) factor 3 outcomes (existential and spiritual wellbeing: .84, 95% CI 73 to .97; p = 0.014). This study informs the new WHO End TB policy with novel data on specific clinical needs. This calls for holistic symptom assessment, person-centred care and holistic management to respond positively to the End TB strategy.

Bayesian Modeling of Spatiotemporal patterns of TB-HIV co-infection risk in Kenya

“…The risk of TB infection developing into TB disease is between 16-27 times higher in HIV infected persons (4). TB can occur both in the early stages and through all stages of HIV infection although the risk intensifies soon after infection with HIV (5).…”

“…The diagnosis of TB in the HIV epidemic remains extremely challenging because of the difficulty in differentiating between reactivation and recent infections (12). The risk of infection or reinfection is dependent on the source case numbers in various congregate settings including households and health-care facilities (5) The disparity for TB infections between persons with and without HIV infection remains a global concern especially because of the high incidence rate among HIV infected persons (13). A study by (14) observed that the prevalence of HIV infections for persons reporting prior TB disease was 33.2% compared to 5.1% in persons without prior TB.…”

Does sexual behaviour of people with HIV reflect antiretroviral therapy as a preventive strategy? A cross-sectional study among outpatients in Kenya

“…The details of the study procedures have been explained in our previous publications [22, 23]. We employed a research assistant who implemented all research activities at the study site.…”

“…We calculated our sample size based on HIV prevalence in Kenya. We have provided these details in our previous publications [22, 23].…”

What will it really take to end the HIV epidemic?

“…The paper of Cockcroft, Marokoane, Kgakole, Tswetla, and Andersson (2018) presents report low enrolment in government structural support programmes by young women, and conclude that these programmes are not presently designed to benefit young women or to prevent HIV. Nkhoma et al (2018) call for holistic symptom assessment, person-centred care and holistic management to respond positively to the End TB strategy in the context of HIV in Kenya.…”