ABSTRACT
Background: Tuberculosis is one of the leading infectious diseases for people living with HIV. Therefore, the purpose of this study was to investigate factors affecting the development of TB among HIV-positive adults under treatment in government hospitals of Amhara Region, Ethiopia. Methods: A hospital-based retrospective study design was conducted among 700 HIV-positive adults under HAART in 17 government hospitals in the Amhara region, Ethiopia. Results: Age of the patients (AOR = 1.122, 95% CI:1.013, 2.234), baseline CD4 cell count (AOR = 0.888, 95% CI: 0.714, 0.945), patients living without their partner (AOR = 1.212, 95% CI: 1.051, 1.123), females under treatment (AOR = 0.786, 95% CI; 0.564, 0.845), non-opportunistic diseases (AOR = 0.865, 95% CI: 0.731, 0.938), patients not disclosed their HIV status (AOR = 1.241, 95% CI: 1.087, 2.341), rural patients (AOR = 1.135, 95% CI: 1.032, 1.453, patient with no education (AOR = 1.125, 95% CI: 1.056, 1.546), low adherence patients (AOR = 1.225, 95% CI: 1.191, 2.453), bedridden patients (AOR = 1.223, 95% CI: 1.131, 1.521), ambulatory patients (AOR = 1.156, 95% CI:1.091, 1.267), non-smoker patients (AOR = 0.854, 95% CI: 0.686, 0.935) significantly affected on the variable of interest. Similarly, alcohol intake, drug toxicity and baseline clinical WHO stages significantly affected for the development of tuberculosis in HIV-positive patients under treatment. Conclusion: In this study, baseline CD4 cell count, female patients, non-opportunistic diseases, and non-smoking status were negatively associated with the development of TB, whereas age of patients, living without partners, patients with no education, patients with low adherence, bedridden and ambulatory patients were positively associated to the development of TB in HIV patients. The findings obtained in this study are important for both service providers and patients. More attention should be given to those positively associated variables to response variables. The regional health bureau should open TB/HIV co-infection subsections like ART sections in each hospital.
ABSTRACT
BACKGROUND: Globally, HIV/AIDS has challenged the lives of 36.3 million people and resulted in 17 million orphans. The disease has neither a vaccine nor a cure and the only option currently is highly active antiretroviral therapy. This research was conducted to identify the predictors of poor adherence to CART and treatment failure at second-line regimen among adults living with HIV/AIDS in public hospitals of Amhara region, north-western Ethiopia. METHODS: A retrospective cohort study design was conducted on 700 HIV-positive people who were receiving a second-line CART regimen. Participants on second-line regimens who followed their treatment between 2016 and 2019 were considered. Data were extracted from participants' clinical charts from June 18-July 7, 2020. RESULTS: A multivariate regression analysis indicates that age of patients (OR = 1.025, 95% CI: 1.001-1.321; p = 0.005), follow-up visits (OR = 0.979, 95% CI: 0.873-0.998; p < 0.001), CD4 cell count change (OR = 0.9860; 95% CI: 0.835-0.998; p < 0.01), marital status (OR = 0.973, 95% CI: 0.789- 0.997; p = 0.006), female HIV-infected patients (OR = 0.990; 95% CI: 0.789-0.999; p <0.001), rural patients (OR = 1.151; 95% CI 1.065-1.398; p = 0.004), non-educated adult patients (OR = 1.026, 95% CI: 1.002-1.198; p = 0.003), existence of social violence (OR = 0.012, 95% CI: 0.008-0.134; p< 0.01), patients with opportunistic diseases (OR = 1.0345, 95% CI 1.002-1.142; p = 0.001), CD4 cell count (OR = 0.901, 95% CI: 0.843-0.995; p = 0.025) and malnutrition (OR = 0.883, 95% CI; 0.762-0.954; p = 0.001) significantly affected the two response variables. CONCLUSION: Several variables affected both poor adherence to HAART and treatment failure at second-line regimens in the current investigation. Due attention should be given to aged patients, rural residents, non-educated patients, and patients with other morbidities to be successful with second-line treatment regimens.
