“Universal test and treat” program reduced TB incidence by 75% among a cohort of adults taking antiretroviral therapy (ART) in Gurage zone, South Ethiopia

Abstract

Background: Tuberculosis (TB) remains the leading cause of morbidity and mortality in peoples living with HIV. At least twenty five percent of deaths are attributed to TB. It is believed that, Universal test and treat (UTT) program for HIV reduces incidence of TB and most countries implement the program. However, there is no study conducted to evaluate the impact of UTT on TB incidence. Therefore, by recruiting a cohort of ART users in the “UTT” and “differed treatment/CD4 based” programs we aimed to measure the effect of the UTT program on incidence of TB. Objective: To measure the effect of “UTT” program on TB incidence among a cohort of adults taking antiretroviral therapy (ART) in Gurage zone, South Ethiopia. Methods: Health facility based retrospective cohort study through record review of 5 year (2014-2019) cohort was conducted in public facilities of Gurage Zone. Randomly selected 384 records were reviewed by using standardized structured checklist by trained professionals. Data was entered by Epi info version 7 and analyzed by STATA. Generalized Linear Model with binomial link function was fitted to measure adjusted incidence density/Incidence rate ratio and identify predictors of incidence difference between the two programs. Results: During the follow up period, 39 incident TB cases were occurred, and making the overall incidence rate of 4.79/100 person-year. It is significantly lower in the UTT (IR=2.10/100 person-year) than the differed program (IR=6.23/100 person-year). The adjusted Incidence Rate Ratio (AIRR) of TB among patients enrolled in the UTT program was; 0.25 (95% CI=0.08-0.70) compared to patients enrolled in the differed program. Thus, UTT program reduce TB incidence by 75%. In addition to the program, IPT use (AIRR= 0.35 (95% CI=0.22-0.48)), WHO Stage I and II (AIRR=0.70 (95% CI=0.61-0.94)) and higher Base line CD4 count (AIRR=0.96 (95% CI=.94-0.99)) significantly reduce incidence of TB. Whereas, treatment failure increase the incidence (AIRR=5.8 (95% CI=1.93-8.46)). Conclusion: TB incidence was significantly reduced by 75% after UTT. Therefore, intervention to further reduce the incidence has to focus on strengthening UTT program and IPT.