TREATMENT OUTCOME AMONG PATIENTS WITH TUBERCULOSIS AND TUBERCULOSIS CO-INFECTED WITH HIV/AIDS ON DOTS IN UNIVERSITY OF NIGERIA TEACHING HOSPITAL, ENUGU

Abstract

Nigeria is ranked 10th among the world TB most burdened country with an incidence of 133/100,000, prevalence of 199/100,000 and death rate from TB dropped from 11% in 2006 to 5% in 2010. The prevalence of HIV/AIDS is 4.1 % in 2010 with HIV prevalence among adult TB cases being 27% in Nigeria. HIV pandemic has markedly increased TB incidence. There has been studies on TB treatment but very few compared those with TB alone and those coinfected with HIV. This study also aims to explore factors influencing the treatment outcomes. The study utilized data from patient with smear sputum positive, enrolled in DOTS program and have completed treatment at Chest clinic University of Nigeria Teaching Hospital, Enugu. Data was collected from their case records and hospital registers and was analysed to determine factors that influenced treatment outcome and compare outcomes among patients with TB alone and those with TB coinfected with HIV. The association of the socio-demographic factors (age, sex, occupation) as well as other factors like CD4 count, disease status, distance covered to clinic with treatment outcome was ascertained using binary logistic regression model., Level of significance was at p=0.05. A total of 437 patients who had sputum smear positive were studied out of which 66 of them were coinfected with HIV. Of the patients that tested positive for HIV, we could access CD4 count of 56 patients. Age group mostly affected by TB was 21-40years (60.7%). Mean age of patients was 35.32±14.33. Male to female ratio was 1.6: 1. Apprentices/applicants, students, artisans were mostly affected. Males had higher prevalence of TB alone (62%) and females higher TB/HIV coinfection (53%). Median CD4 count was 203 cells/mm3. Treatment outcomes included cured (73.7%), failure(1.8%), RAD(l.4%), Relapse(1.1 %). Those that had TB alone had 76% cure against those with TB/HIV coinfection 62%. There was no association between treatment outcome and age categories, sex, occupation, CD4 count, but there were associations with disease status and distance from residence to clinic. Those that had TB coinfected with HIV were 1.7(95%CI: 0.980, 3.046) less likely to be cured than those with TB alone. Those that covered distances >20km were less likely to be cured when compared with those that covered< 20km. Coinfection of TB/HIV constitutes a major threat to control of TB. HIV prevalence among TB patients and paucity of DOTS centres including poor citing of health facilities leading to distance in accessing TB care are some of the factors hampering treatment outcome. For treatment outcome to be improved HIV pandemic must be tackled and access to services addressed.