Effect of Isoniazid Preventive Therapy on the Incidence of Tuberculosis among Seropositive Children Attending HIV/AIDS Care in Two General Hospitals, Northwest Ethiopia, 2021

Abstract

The human immune deficiency virus (HIV) is the strongest risk factor for the incidence of tuberculosis (TB) by way of reactivation of latent or new infection. The provision of isoniazid preventive therapy (IPT) is one of the public health interventions for the prevention of TB. To date, there have been limited clinical data regarding the effectiveness of isoniazid preventive therapy (IPT) on TB incidence. This study aimed to assess the effect of isoniazid preventive therapy on the incidence of tuberculosis for seropositive children in Northwest Ethiopia. Methods. A facility-based retrospective follow-up was employed for reviewing 421 files from 1 January 2015 up to 30 December 2019. EpiData version 3.2 and Stata/14 software were used for data entry and analysis, respectively. Categorical variables at bivariable Cox regression were assessed for candidates transferred at P value <0.25 for multivariable Cox regression to claiming predictors associated with TB incidence rate at 95% CI at P < 0.005 . Result. The overall incidence of TB was found to be 4.99 cases per 100 person-years at 95% CI (3.89–6.53). Missed IPT (AHR = 7.45, 95% CI: 2.96, 18.74, P < 0.001 ), missed cotrimoxazole preventive therapy (CPT) (AHR = 2.4, 95% CI: 1.84–4.74, P < 0.022 ), age ≥ 11 years (AHR = 4.2, 95% CI: 1.04–7.03, P < 0.048 ), MUAC ≤ 11.5 cm (AHR = 4.36, 95% CI: 1.97–9.97, P < 0.001 ), WHO stages III and IV (AHR = 2.04, 95% CI: 1.12–3.74, P < 0.022 ), and CD4 count ≤100 cells/μl (AHR = 3.96, 95% CI: 1.52–10.34, P < 0.005 ) were significantly associated with TB incidence. Conclusion. Concomitant administration of ART with IPT had demoted more than ninety-six percent of new TB incidences for this report. Undertaking in-depth TB screening and frequent follow-up among all these children is critical in order to prevent and control tuberculosis.

Incidence and Predictors of Pulmonary Tuberculosis among Children Who Received Antiretroviral Therapy (ART), Northwest Ethiopia: A Multicenter Historical Cohorts Study 2009–2019

“…This is consistent with a previous document in Northwest Ethiopia and Gondar hospitals [ 14 , 26 ]. Moreover, in line with research finding with Northwest Ethiopia, Zaire, and Cameroon [ 4 , 23 , 27 ], our study indicated seropositive children who did not take IPT at baseline had a risk of developing PTB. Consistent with research findings in Northwest Ethiopia [ 4 ], concomitant administration of IPT with ART after undertaking in-depth active TB signs, power to have demoted more than ninety-six percent of new TB incidence for children living with HIV.…”

“…Gilgel Belles is the capital of Metekel zone, which is located at 565 and 394 km away from Addis Ababa and Assosa, on the way to GERD projects (Ethiopian Great Renaissance Damp at Abay River). Apart from other health service, all these health institutions have been providing ART care services since 2007 [ 4 , 13 ].…”

“…A facility-based historical cohort study design was employed among 721 seropositive children in two hospitals and two health centers from January 1, 2009, to December 31, 2019. All these health facilities provide health care services for an estimated 2968 total catchment populations as depicted in [ 4 , 14 ] Figure 1 .…”

“…ART has decreased TB incidence in HIV‐infected patients [ 3 ]. The waning of the immune system increased Mycobacterium tuberculosis susceptibility and progression of dormant tuberculosis bacilli to endogenous reactivation of latent incidence in the lung [ 4 ]. Pulmonary complications have been one of the commonest causes of morbidity and mortality since the advent of the AIDS pandemic and this further led to the parallel pandemic of tuberculosis in some sub-Saharan African populations where 10%–15% suffered from multiple infections [ 2 , 5 ].…”

Time to Develop and Predictors for Incidence of Tuberculosis among Children Receiving Antiretroviral Therapy

“…The Ethiopian Federal HIV and AIDS Prevention and Control Office estimated that the single national HIV/AIDS is among the top ten high burden counties with an incidence rate of 341/100,000 of which 31% of TB patients are living with HIV [ 5 , 7 ]. Still now, TB/HIV coinfection is the leading cause of death in people living with HIV/AIDS [ 12 ]. Although the incidence of TB among adult HIV patients has been exhaustively studied, it is overlooked for HIV-positive children receiving antiretroviral therapy.…”