Estimation of lifetime survival and predictors of mortality among TB with HIV co-infected children after test and treat strategies launched in Northwest, Ethiopia, 2021; a multicentre historical follow-up study

Abstract

Introduction In resource-limited settings, the mortality rate among tuberculosis and human Immunodeficiency virus co-infected children is higher. However, there is no adequate evidence in Ethiopia in general and in the study area in particular. Hence, this study aims to estimate lifetime survival and predictors of mortality among TB with HIV co-infected children after test and treat strategies launched in Northwest Ethiopia Hospitals, 2021. Methods Institution-based historical follow-up study was conducted in Northwest Ethiopia Hospitals among 227 Tuberculosis and Human Immunodeficiency Virus co-infected children from March 1, 2014, to January 12, 2021. The data were entered into Epi info-7 and then exported to STATA version 14 for analysis. The log-rank test was used to estimate the curve difference of the predictor variables. Bivariable cox-proportional hazard models were employed for each predictor variable. Additionally, those variables having a p-value < 0.25 in bivariate analysis were fitted into a multivariable cox-proportional hazards model. P-value < 0.05 was used to declare significance associated with the dependent variable. Results From a total of 227 TB and HIV co-infected children, 39 died during the follow-up period. The overall mortality rate was 3.7 (95% CI (confidence interval): 2.9–4.7) per 100 person-years with a total of 1063.2-year observations. Cotrimoxazole preventive therapy (CPT) non-users [Adjusted Hazarded Ratio (AHR) = 3.8 (95% CI: 1.64–8.86)], presence of treatment failure [AHR = 3.0 (95% CI: 1.14–78.17)], and Cluster of differentiation 4(CD4) count below threshold [AHR = 2.7 (95% CI: 1.21–6.45)] were significant predictors of mortality. Conclusion In this study, the mortality rate among TB and HIV co-infected children was found to be very high. The risk of mortality among TB and HIV co-infected children was associated with treatment failure, CD4 count below the threshold, and cotrimoxazole preventive therapy non-users. Further research should conduct to assess and improve the quality of ART service in Northwest Ethiopia Hospitals.

Mortality of children and adolescents co-infected with tuberculosis and HIV: a systematic review and meta-analysis

“…A total of seven studies [21,24,25,33,38,43,47] provided data on mortality rates among children and adolescents with HIV-TB co-infection across various age groups. The pooled mortality rates were 32% (95% CI [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] for those aged <12 months, 14% (95% CI [10][11][12][13][14][15][16][17][18][19] for the 1-5 years age group, 15% (95% CI 12-17) for the 5-10 years age group, and 16% (95% CI [13][14][15][16][17][18][19][20] for those aged over 10 years old (Figure 4, Supplemental Digital Content, http://links.lww.com/QAD/D142). As illustrated in Fig.…”

“…3, a statistically significant lower risk of death was observed in the 1-5 years age group (OR 0.40; 95% CI 0.20-0.78; P < 0.05), the 5-10 years age group (OR 0.34; 95% CI 0.16-0.72; P < 0.05), and the over 10 years age group (OR 0.35; 95% CI 0.22-0.55; P < 0.05) when compared with those under 12 months. Data from nine studies [21,24,25,27,33,36,38,43,52] reported mortality rates among children and adolescents with HIV-TB co-infection, stratified by gender. The combined mortality rates were 12% (95% CI 9-16) for males and 10% (95% CI 7-16) for females (Figure 5, Supplemental Digital Content, http://links.lww.com/ QAD/D142).…”

Active tuberculosis incidence among treatment failure experienced patients in North Wollow Zone: A multicenter historical cohort

“…were HIV positive and in 2014, 12% of the 9.6 million new TB cases occurred in individuals with HIV. 3,4 According to the WHO 2019 report, TB caused 10.1 million new cases and 1.7 million deaths, making it the leading cause of death from a single infectious agent (9). In Africa, the resurgence of TB is linked to TB-HIV/AIDS connection and a shortage of skilled healthcare personnel, not control program deterioration 5,6 In Africa, TB is the second largest disease burden (25%), following Southeast Asia (44%) (12,13).…”

“…The decline in the immune system exacerbates the reactivation of latent tuberculosis bacilli in the lungs. In 2012, out of 8.6 million tuberculosis cases, 13% were HIV positive and in 2014, 12% of the 9.6 million new TB cases occurred in individuals with HIV 3,4 . According to the WHO 2019 report, TB caused 10.1 million new cases and 1.7 million deaths, making it the leading cause of death from a single infectious agent (9).…”

Viral Load and CD4+ Markers as Determinants of Tuberculosis Coinfection Among People Living with HIV/AIDS in Papua Indonesia

“…1 TB-HIV coinfection also has a high case fatality rate and a lifetime risk. 8,9 HIV is one of the important factors contributing to the global increase in TB. Due to primary infection, re-infection increases the risk of progression from one stage of TB to the next.…”