Human immunodeficiency virus as a determinant of tuberculosis treatment outcome in tuberculosis patients treated at Arba Minch General Hospital: a five-year retrospective study

Abstract

Introduction: Tuberculosis/human immunodeficiency virus (TB/HIV) co-infection has a mutual and synergistic effect which mostly affects interventions that have been taken on the area. TB/HIV co-infected patients have a worse treatment outcome as compared to HIV-negative patients. There are limited data regarding the impact of HIV on the TB treatment success rate. The aim of this study was to determine the effect of HIV on TB treatment under the implementation of the directly observed treatment strategy. Material and methods: Five-year retrospective data (from August 2012 to July 2016) of tuberculosis patients (n = 544) registered at the directly observed therapy short-course (DOTS) clinic of Arba Minch General Hospital were reviewed. The association of TB treatment outcome with HIV seropositivity was assessed according to the national tuberculosis control program guideline. Data were entered and analyzed using SPSS version 16. Odds ratios with 95% confidence intervals were used to evaluate the presence and strength of association between TB treatment outcome and HIV status. Results: Out of the 544 TB patients, 29.2% (159) were HIV co-infected. Overall, the treatment success rate of TB patients with or without HIV was 74.6%. Using cure/completion as a reference, patients with HIV seropositivity had significantly higher odds of default (COR = 1.37; 95% CI: 0.669-2.825), failure (COR = 20.79; 95% CI: 1.065-406.019), death (COR = 6.95; 95% CI: 1.765-27.394) and transfer-out (COR = 2.59; 95% CI: 1.557-4.334). Conclusions: The rate of treatment success in this study is still lower than the recommended 85% target set by the WHO and Ministry of Health of Ethiopia (97%). In order to further improve the treatment success rate, continuous follow-up with frequent support of patients during the treatment course and strengthening the recording system are strongly recommended.

Treatment Outcomes and Predictors Among Tuberculosis Patients at Madda Walabu University Goba Referral Hospital, Southeast Ethiopia

“…This finding is consistent with other retrospective studies from Ethiopia with a treatment failure rate of 0.6% in Addis Ababa, 34 0.8% in Gondar, 31 0.5% in Tigray 13 and 0.6% in Arba Minch. 19 Nonetheless, the rate of treatment failure of the current research is slightly superior to other research findings done in northern (0.3%) 36 parts of Ethiopia, and similar studies from Zambia (0.3%) 37 and Pakistan (0.2%). 30 Ccontrary to this, our treatment failure rate finding is lower than other similar studies, Melese and Ewnete 3.5% 33 and Tesema et al 1.4% 16 in Ethiopia and 8.3% in southern Nigeria.…”

“…On the contrary, the mortality rate of our study was comparatively close to different studies from other regions in the country with 5% in Adama, 16 5.6% in Debre Tabor, 33 2.9% in Tigray region, 13 1.8% in Arba Minch, 19 3.7% in Addis Ababa, 34 3.9% in Harar 12 and 3.8% in northern Shoa 20 and elsewhere in China (2.8%) 28 and Pakistan (1.8%). 30 However, our study finding is much lower than the mortality rate (19.4%) of the study done in Nigeria.…”

“…The success rate in the current study was in line with the retrospective studies conducted in eastern Ethiopia, Harar with success rate of 92.5%, 12 89.2% in Tigray, 13 overall mean treatment success rate 92.4% in Hawassa, 14 89% in Sidama zone, 15 the Ethiopian national strategic goals (90%) set for 2020 11 and the WHO 2030 international target of ≥90%. 8 The treatment success rate in our study (91.2%) was higher than previous similar studies in Adama (80.8%), 16 retrospective studies in Addis Ababa 82.7%, 17 Hosanna (43.3%), 18 Arba Minch (74.6%), 19 86.1% in Amhara region, northern Shoa, 20 a study from selected hospitals in Ethiopia (55.8%) 21 and the pooled estimate of TB treatment success rate in Ethiopia (86%). 22 The finding in this study is still higher than the finding from other countries with treatment success rate of 57.7% in Nigeria, 23 81% in northern Tanzania, 24 77.4% in Yemen, 25 53.4% in Malaysia 26 and 80.5% in Denmark 27 and a study from China by Bao et al with 88%.…”