Statistical Analysis on Determinant Factors Associated with Time to Death of HIV/TB Co-Infected Patients Under HAART at Debre Tabor Referral Hospital: An Application of Accelerated Failure Time-Shared Frailty Models

Abstract

Background: Human immune virus/tuberculosis co-infection in one's immune system potentiates each other and hastening the weakening of the host's immunological capabilities while growing active TB, which will increase susceptibility to primary contamination, re-contamination, and/or reactivation for sufferers with latent TB. The goal of this study was to identify determinant factors associated with the survival time to death of HIV/TB co-infected adult patients under HAART at Debre Tabor referral hospital. Methods: A retrospective follow-up analysis was undertaken for 243 HIV/TB coinfected patients who were receiving ART treatment and had follow-ups between January 2014 and December 2019. To compare the survival experiences of different patient groups, the Log rank test was performed. The Weibull accelerated failure time gamma shared frailty model was used to find determinants of HIV/TB co-infected patients' survival time. Results: Among HIV/TB co-infected patients, 87 (35.39%) died of whom 77 (88.5%) patients were females. The Weibull AFT gamma shared frailty model showed that sex, baseline age, adherence status, educational status of respondents, functional status, WHO clinical stage, baseline hemoglobin and type of TB were among the potential determinants of survival time of HIV/TB co-infected patients. Furthermore, the findings of this study demonstrated that there is a clustering impact on patient time to death that results from the residency of HIV/TB co-infected patients' survival time. Conclusion and Recommendation:The majority of patients reside in rural area, have poor adherence to treatment, and have low CD4 cell counts. Educational status, WHO clinical stages, adherence status, and hemoglobin levels of patients are all important determinants of HIV/TB co-infected patients' survival. As a result, to improve the survival of HIV/TB co-infected patients at the start of and during some stages of anti-TB treatment, the concerned body, FMOH, in collaboration with Regional Health Bureau, should emphasize the importance of following treatment for HIV/TB coinfected patients with poor adherence status, advanced WHO clinical stages, and a low CD4+ count.

A survival analysis of prognostic determinant factors of time-to-death of HIV/TB co-infected patients under HAART followed-up in a public hospital in Ethiopia

“…But, in the present study, the lognormal AFT model was the best fit for the data. The followup period of this study also revealed that there were 29.5% deaths among HIV/TB co-infected patients, which might be comparable with a study of Sanzana [17] and higher and lower than studies of [18][19][20][21][22][23] and [1,16,[24][25][26], respectively. In this study, female patients presented slightly higher survival time than male patients as indicated in the K-M plot of patients, which might show a comparable result with studies of Sanzana [17] and Kosgei et al [27].…”

Parametric Bayesian Modelling of Tuberculosis Mortality determinants and Facility level heterogeneity effect using Gamma and Gaussian shared frailty techniques

“…The results showed a statistically significant community level effect on the risk of dying and demonstrated variations from catchment area to catchment area especially for results from Gaussian distribution. This approach is similar to those carried out by other researchers previously (5,11,12).…”

“…Several factors affecting survival of patients are missed in the TB treatment programs. Many studies assessing risk factors for survival of TB patients use the survival time statistical analysis which does not take into consideration the natural variability of the different environments among the patients (5).…”

Active tuberculosis incidence among treatment failure experienced patients in North Wollow Zone: A multicenter historical cohort

“…In Africa, the resurgence of TB is linked to TB-HIV/AIDS connection and a shortage of skilled healthcare personnel, not control program deterioration 5,6 In Africa, TB is the second largest disease burden (25%), following Southeast Asia (44%) (12,13). Additionally, one-third of HIV-associated deaths are attributed to TB (9,11). In 2018, approximately 251,000 deaths occurred among HIV-infected individuals due to TB, accounting for 33% of all deaths.…”

“…By 2019, tuberculosis (TB) had surpassed HIV/AIDS as the leading cause of infectious agent-related deaths worldwide, with an estimated 10.1 million new cases and 1.7 million fatalities, marking a significant shift before 2020. 11,12 In sub-Saharan Africa, incidence rates for children and adolescents are high, with 2,017 cases per 100,000 patient-years (20). The twin epidemic of TB and HIV caused 0.3 million deaths worldwide in 2017, with a lifetime risk increase from 15% to 22% (1).…”