Delayed initiation of anti-retroviral therapy in TB/HIV co-infected patients, Sanyati District, Zimbabwe, 2011-2012

Maponga, Brian Abel; Chirundu, Daniel; Gombe, Notion Tafara; Tshimanga, Mufuta; Bangure, Donewell; Takundwa, Lucia

doi:10.11604/pamj.2015.21.28.5195

Cited by 6 publications

(6 citation statements)

References 10 publications

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“…However, not much attention has been given to prevent DP for the vulnerable groups particularly Tb/HIV co-infected patients which remains one of the vastest defies in the reduction of HIV infection in resource scare countries including Ethiopia. Nearly 60 % of the patients in our study were delayed presenters, a finding that is similar with a study conducted in Zimbabwe [38]. This is also a comparable magnitude with DP of general HIV population in Africa [22, 26].…”

Section: Discussionsupporting

confidence: 90%

“…Findings of a previous study conducted in Zimbabwe [38] depicted that being treated for Tb first time, staying more than 5 km from a clinic, and having a family member on ART were factors for delayed ART initiation. In addition, findings of another study from Malawi [47] revealed that cost of transport to the hospital ART site was significantly associated with ART acceptance.…”

Section: Discussionmentioning

confidence: 99%

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The prevalence and associated factors for delayed presentation for HIV care among tuberculosis/HIV co-infected patients in Southwest Ethiopia: a retrospective observational cohort

et al. 2016

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BackgroundA delay presentation for human immunodeficiency virus (HIV) patient’s care (that is late engagement to HIV care due to delayed HIV testing or delayed linkage for HIV care after the diagnosis of HIV positive) is a critical step in the series of HIV patient care continuum. In Ethiopia, delayed presentation (DP) for HIV care among vulnerable groups such as tuberculosis (Tb) /HIV co-infected patients has not been assessed. We aimed to assess the prevalence of and factors associated with DP (CD4 < 200 cells/μl at first visit) among Tb/HIV co-infected patients in southwest Ethiopia.MethodsA retrospective observational cohort study collated Tb/HIV data from Jimma University Teaching Hospital for the period of September 2010 and August 2012. The data analysis used logistic regression model at P value of ≤ 0.05 in the final model.ResultsThe prevalence of DP among Tb/HIV co-infected patients was 59.9 %. Tb/HIV co-infected patients who had a house with at least two rooms were less likely (AOR, 0.5; 95 % CI: 0.3–1.0) to present late than those having only single room. Tobacco non-users of Tb/HIV co-infected participants were also 50 % less likely (AOR, 0.5; 95 % CI: 0.3–0.8) to present late for HIV care compared to tobacco users. The relative odds of DP among Tb/HIV co-infected patients with ambulatory (AOR, 1.8; 95 % CI, 1.0–3.1) and bedridden (AOR, 8.3; 95 % CI, 2.8–25.1) functional status was higher than with working status.ConclusionsThree out of five Tb/HIV co-infected patients presented late for HIV care. Higher proportions of DP were observed in bedridden patients, tobacco smokers, and those who had a single room residence. These findings have intervention implications and call for effective management strategies for Tb/HIV co-infection including early HIV diagnosis and early linkage to HIV care services.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0193-y) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

The prevalence and associated factors for delayed presentation for HIV care among tuberculosis/HIV co-infected patients in Southwest Ethiopia: a retrospective observational cohort

et al. 2016

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“…Earlier studies looking at spatial heterogeneity of viral suppression in this province reported similar results [8,25]. People in this province are likely to present late for health care [26], delay ART initiation [27] or engage in sexual activities with multiple partners which subsequently compromise viral suppression among HIV patients [28,29]. Therefore, interventions such as self-testing [30], pre-exposure prophylaxis (PrEP) pills for high-risk groups [31] should be intensified in such regions.…”

Section: Discussionmentioning

confidence: 65%

Markov modelling of viral load adjusting for CD4 orthogonal variable and multivariate conditional autoregressive mapping of the HIV immunological outcomes among ART patients in Zimbabwe

Matsena-Zingoni

Chirwa

Todd

et al. 2021

Theor Biol Med Model

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Background This study aimed to jointly model HIV disease progression patterns based on viral load (VL) among adult ART patients adjusting for the time-varying “incremental transients states” variable, and the CD4 cell counts orthogonal variable in a single 5-stage time-homogenous multistate Markov model. We further jointly mapped the relative risks of HIV disease progression outcomes (detectable VL (VL ≥ 50copies/uL) and immune deterioration (CD4 < 350cells/uL) at the last observed visit) conditional not to have died or become loss to follow-up (LTFU). Methods Secondary data analysis of individual-level patients on ART was performed. Adjusted transition intensities, hazard ratios (HR) and regression coefficients were estimated from the joint multistate model of VL and CD4 cell counts. The mortality and LTFU transition rates defined the extent of patients’ retention in care. Joint mapping of HIV disease progression outcomes after ART initiation was done using the Bayesian intrinsic Multivariate Conditional Autoregressive prior model. Results The viral rebound from the undetectable state was 1.78times more likely compared to viral suppression among patients with VL ranging from 50-1000copies/uL. Patients with CD4 cell counts lower than expected had a higher risk of viral increase above 1000copies/uL and death if their VL was above 1000copies/uL (state 2 to 3 (λ23): HR = 1.83 and (λ34): HR = 1.42 respectively). Regarding the time-varying effects of CD4 cell counts on the VL transition rates, as the VL increased, (λ12 and λ23) the transition rates increased with a decrease in the CD4 cell counts over time. Regardless of the individual’s VL, the transition rates to become LTFU decreased with a decrease in CD4 cell counts. We observed a strong shared geographical pattern of 66% spatial correlation between the relative risks of detectable VL and immune deterioration after ART initiation, mainly in Matabeleland North. Conclusion With high rates of viral rebound, interventions which encourage ART adherence and continual educational support on the barriers to ART uptake are crucial to achieve and sustain viral suppression to undetectable levels. Area-specific interventions which focus on early ART screening through self-testing, behavioural change campaigns and social support strategies should be strengthened in heavily burdened regions to sustain the undetectable VL. Sustaining undetectable VL lowers HIV transmission in the general population and this is a step towards achieving zero HIV incidences by 2030.

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“…A possible explanation to this observation is that those who die in the first few weeks of treatment report to the hospitals late. The causes of delay may be due to fear of drug toxicities, stigmatisation, self-medication, delay in diagnosis of TB and/or HIV infection and counselling among other others [8, 29].…”

Section: Discussionmentioning

confidence: 99%

Effect of HIV infection on TB treatment outcomes and time to mortality in two urban hospitals in Ghana-a retrospective cohort study

Ogyiri¹,

Lartey²,

Ojewale³

et al. 2019

Pan Afr Med J

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Introduction Tuberculosis (TB) is currently causing more deaths than Human Immunodeficiency Virus (HIV) globally. Ghana as one of the 30 high burden TB/HIV countries has a high annual TB case-fatality rate of 10%. The study sought to assess the effect of HIV infection on TB treatment outcomes and assess the time to mortality after treatment onset. Methods We conducted a review of treatment files of TB patients who were treated from January 2013 to December 2015 in two urban hospitals in the Accra Metropolis. Modified Poisson regression analysis was used to measure the association between HIV infection and TB treatment outcomes. Kaplan-Meier survival estimates were used to plot survival curves. Results Seventy-seven percent (83/107) of HIV infected individuals had successful treatment, compared to 91.2% (382/419) treatment success among HIV non-infected individuals. The proportion of HIV-positive individuals who died was 21.5% (23/107) whilst that of HIV-negative individuals was 5.5% (23/419). Being HIV-positive increased the risk of adverse outcome relative to successful outcome by a factor of 2.89(95% CI 1.76-4.74). The total number of deaths recorded within the treatment period was 46; of which 29(63%) occurred within the first two months of TB treatment. The highest mortality rate observed was among HIV infected persons (38.6/1000 person months). Of the 107 TB/HIV co-infected patients, 4(3.7%) initiated ART during TB treatment. Conclusion The uptake of ART in co-infected individuals in this study was very low. Measures should be put in place to improve ART coverage among persons with TB/HIV co-infection to help reduce mortality.

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Delayed initiation of anti-retroviral therapy in TB/HIV co-infected patients, Sanyati District, Zimbabwe, 2011-2012

Cited by 6 publications

References 10 publications

The prevalence and associated factors for delayed presentation for HIV care among tuberculosis/HIV co-infected patients in Southwest Ethiopia: a retrospective observational cohort

The prevalence and associated factors for delayed presentation for HIV care among tuberculosis/HIV co-infected patients in Southwest Ethiopia: a retrospective observational cohort

Markov modelling of viral load adjusting for CD4 orthogonal variable and multivariate conditional autoregressive mapping of the HIV immunological outcomes among ART patients in Zimbabwe

Effect of HIV infection on TB treatment outcomes and time to mortality in two urban hospitals in Ghana-a retrospective cohort study

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