Prevalence and associated risk factors for tuberculosis among people living with HIV in Nepal

Abstract

Background Worldwide tuberculosis (TB) takes more lives than any other infectious diseases. WHO estimates around 68,000 incident TB cases in Nepal. However, in 2018 only around 27,232 new TB cases were reported in the national system, resulting around 40,768 incident TB cases missing every year in Nepal. National Tuberculosis Control Center carried out this study in anti-retroviral therapy (ART) sites to estimate the prevalence of TB and identify the associated risk factors for TB among the people living with Human Immunodeficiency Virus (PLHIVs) in Nepal. Methods It was a cross-sectional institution-based study conducted between March and August 2018. Six ART sites with high caseloads of PLHIVs were selected. PLHIVs who were equal or above 18 years of age and were in ART program at the selected study sites were considered eligible for the study. Diagnosis of tuberculosis among PLHIVs who agreed to participate in the study was carried out as per the National Tuberculosis Management Guideline of National Tuberculosis Program of Nepal. Results Among 403 PLHIVs, tuberculosis was diagnosed in 40 (9.9%) individuals. Median age of the participants was 36 (30–43) years. Prevalence of TB was significantly higher among male PLHIVs than female PLHIVs (13.6% Vs 5.8%; P = 0.02) and Dalit ethnic group compared to Brahmin/Chettri (22.0%Vs5.9%, P = 0.01). The risk of developing TB was found significant among those with HIV stage progressed to WHO stage 3 and 4 (OR = 4.85, P<0.001) and with the family history of TB (OR = 4.50, P = 0.002). Conclusions Prevalence of TB among PLHIVs in Nepal was found 9.9%. Risk of developing TB was higher among PLHIVs who were male, Dalit, with HIV stage progressed to WHO stage 3 and 4 and with family history of TB. Hence, targeted interventions are needed to prevent the risk of developing TB among PLHIVs. Similarly, integrated, and comprehensive TB and HIV diagnosis and treatment services are needed for the management of TB/HIV co-infection in Nepal.

Heterogeneity in practitioner-reported barriers to use, cost considerations and priorities for point of care sexually transmitted infection tests on surveys across seven years

“…Our study revealed both similarities and differences in economic and other factors influencing practitioners' STI POCT use, perceived barriers to test adoption, priorities for test development, and desired test characteristics longitudinally and between participants from HICs versus LMICs. This study extends results from a similar clinician survey conducted by our group in 2009, in which >89% of participants were from the US, Canada or Europe 9,11 and adds to the limited literature on practitioner preferences for STI POCT 7 by enabling comparisons between HICs and LMICs over time.…”

Intersectional gender analysis for inclusive health system in Nepal: taking Tuberculosis as a case example

“…However, various studies conducted in other countries have shown that migrant population and ethnic minorities have higher prevalence of TB in comparison to general population [49][50][51][52][53]. This could be because of interactions between cultural and structural barriers to accessing healthcare [3,4,[50][51][52][53][54]. Behind this, social power and structures have influenced vulnerability and treatment outcome of TB among people living in slums and densely populated urban settings, people living in congregate settings like factories, prisons, camps and refugees [44].…”

“…Our study did not identify significant differences in TB related outcomes across ethnic groups. However, various studies conducted in other countries have shown that migrant population and ethnic minorities have higher prevalence of TB in comparison to general population [49][50][51][52][53]. This could be because of interactions between cultural and structural barriers to accessing healthcare [3,4,[50][51][52][53][54].…”

Incidence of tuberculosis among PLHIV on antiretroviral therapy who initiated isoniazid preventive therapy: A multi-center retrospective cohort study

“…WHO clinical stages III and IV are indicators of advanced HIV disease and likely a compromised immune status [ 37 ]. As such, individuals who present in these stages often possess cell of differentiation (CD4) count of less than 200 cells/μL, making them substantially vulnerable to developing TB disease [ 38 ] regardless of IPT status. Perhaps, findings by Golub et al substantiate this suggestion [ 39 ].…”