Five years retrospective cohort analysis of treatment outcomes of TB-HIV  patients at a PEPFAR/DOTS Centre in South Eastern Nigeria.

Omotowo I Babatunde1, Ekwueme O Christiandolus, Eke C Bismarck, Obi I Emmanuel, Agunwa C Chike1, Eyisi I Gabriel
1. Department of Community Medicine, College of Medicine, University of Nigeria,
Enugu Campus/University of Nigeria Teaching Hospital, Enugu.
2. Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria

Abstract
Background: Human immunodeficiency virus (HIV) associated tuberculosis (TB) remains a major global public health challenge, with an estimated 1.4 million patients worldwide. Co-infection with HIV leads to challenges in the diagnosis and treatment  of patients.

Objectives:The aim of this study was to assess treatment outcomes of a cohort of smear positive TB-HIV co-infected patients  over a five-year study period.

Methods:A retrospective cohort study of 600 smear-positive tuberculosis patients registered at the chest unit of the University  of Nigeria Teaching Hospital, Enugu from January 2008 to December 2012 was done. The data was analyzed using SPSS Version 17.

Results: One hundred and three (17.2%) of the patients were co-infected with TB/HIV, while 398 (66.3%) and 99 (16.5%) were  HIV negative and unknown respectively. Among the co-infected patients, 45(43.7%) were cured as against 222(55.8%) in the TBHIV negatives (Z=4.53, p=0.000, 95%CI= 0.12-0.34). Respectively in the TB-HIV co-infected and TB-HIV negative patients,  treatment completed were 21(20.4%) and 71(17.8%) (Z=9.15, p=0.000, 95%= 0.4035-0.60); defaulted 19(18.5%) vs 70 (17.6%)  (Z=9.29, p=0.000, 95%CI=0.42-0.60), died 10(9.7%) vs. 6(1.5%) (Z=1.22, p=0.224, 95%CI= -0.0286-0.1086), and failures were  1(0.9%) vs. 7(1.8%) (Z=2.48, p=0.013, 95%CI=0.04-0.10). Treatment success rate was lower in TB-HIV co-infected patients, 64.1% compared to TB-HIV negative patients with 73.6%. Also those that defaulted among the TB-HIV co-infected patients (18.5%) were higher than 17.6% among TB-HIV negative patients, a difference of 0.9%.

Conclusion:Findings demonstrate that HIV co-infection affects TB treatment outcomes adversely. Treatment adherence, timely and sustained access to antiretroviral therapy for TB/HIV co-infected patients are important.

Keywords:Retrospective cohort analysis, PEPFAR/DOTS centre, South Eastern Nigeria