TB/HIV CO-INFECTED PATIENTS MORTALITY STATUS AND ITS PREDICTORS IN DIRE DAWA, EASTERN ETHIOPIA

Abstract

Introduction: Tuberculosis and human immunodeficiency virus co-infection is an important global public health problem. HIV infection is a leading for tuberculosis over-diagnosis of sputum smear-negative pulmonary tuberculosis due to difficulties in diagnosis, under-diagnosis of sputum smear-positive PTB due to excess laboratory workload. Likewise, tuberculosis increases human immune virus replication. Even though national efforts to combat TB/HIV co-infection have improved the survival of patients after initiating TB and HIV treatment. Gaps remain in survival of patients after anti-TB initiation in general, particularly Eastern of Ethiopia. Objective: To determine tuberculosis and human immunodeficiency virus co-infected patients’ mortality rate and its predictors in Dire Dawa, Eastern Ethiopia. Method: Institution based retrospective cohort study was employed on 471 randomly selected tuberculosis and human immunodeficiency virus co-infected patients enrolled from January, 2012- December, 2016. The collected data was entered into Epi-data 4.2.0.0 and exported to Statistical Package for Social Science version 24 for analysis. Relevant variables information were collected from patients ‘medical cards. Univariate analysis were used to describe the baseline characteristics of the patients. Kaplan Meir curve were used for the comparison of time to recovery among the different groups of patients. Cox model were used to identify independent predictors of survival. Result: A total of 79(16.8%) deaths occurred during the median study period of 685 days. The Cox-regression analysis showed that being pulmonary tuberculosis infection[AHR=1.99(95%CI:1.16-3.41)],WHO clinical stage III [AHR=2.88(95%CI:1.56-5.30)], IV[AHR=4.20(95%CI:2.21-8.01)], ambulatory functional status[AHR=4.15(95%CI:1.57-10.98)], bedridden functional status [AHR=6.34(95%CI:2.43-16.59)] and delayed Co-trimoxazole preventive therapy [AHR=2.45(95%CI:1.54-3.91)] were important predictors associated with high mortality rate at 0.05 level of significance. Conclusion and Recommendation: The findings of this study shows that 16.8%TB-HIV co-infected individuals died. The independent predictors were PTB infection, WHO clinical staging III and IV, ambulatory and bed ridden functional status and not Co-trimoxazole preventive therapy. Therefore, the health office should work together with health institutions and give more emphasis early detection and diagnosis of tuberculosis and HIV testing.