Profile, Outcomes, and Determinants of Unsuccessful Tuberculosis Treatment Outcomes among HIV-Infected Tuberculosis Patients in a Nigerian State

Abstract

Background. Few studies have evaluated the rate of tuberculosis (TB)/human immunodeficiency virus (HIV) coinfection and the determinants of its treatment outcomes in Africa. We aimed to determine the predictors of unsuccessful treatment outcomes in HIV-infected tuberculosis patients in Nigeria. Methods. A retrospective cohort study design was used to assess adult TB/HIV patients who registered for TB treatment in two health facilities in Ebonyi State, Southeast Nigeria, between January 2011 and December 2012. Predictors of unsuccessful treatment outcomes were determined using multivariable logistic regression analysis. Results. Of 1668 TB patients, 342 (20.5%) were HIV coinfected. Of these, 195 (57%) had smear-negative pulmonary TB and 11 (3.2%) had extrapulmonary TB. Overall, 225 (65.8%) patients achieved successful outcomes, while 117 (34.2%) had unsuccessful outcomes. The unsuccessful treatment outcomes were due to “default” (9.9%), “death” (19%), “treatment failure” (1.5%), and “transferring out” (3.8%). Independent determinants for unsuccessful outcomes were receiving care at a public facility and noninitiation of antiretroviral therapy. Conclusion. There is need for the reevaluation of the quality of public sector treatment services provided for TB/HIV patients as well as further expansion of TB/HIV collaborative activities in rural areas, and interventions to reduce mortality and default rates among TB/HIV patients are urgently needed in Nigeria.

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

“…These findings compare favourably with the results of the similar survey studies on TB/HIV done in different tertiary institutions in Nigeria [15][16][17] ; and in Ethiopia 18 where worst treatment outcomes were found among the co-infected than those with TB disease only. Although several other factors may be contributory to the recorded unfavourable treatment outcomes among the TB/HIV infected patients, but the dual immune depressing diseases have been found to be the major culprits.…”

Tuberculosis Treatment Outcomes and Determinants among Patients Treated in Hospitals in Imo State, Nigeria

“…This pattern of high TB treatment success among new cases has been reported by several studies [25] [27] [28] [43]. Yet some others reported no significant effect on the treatment outcome by both the drug regimen used and the type of patient at diagnosis [19] [23] [41]. This report could likely be due to the fact that most category II patients are re-treatment cases and might have been long on the drugs leading to poor compliance to drugs, development of resistance to drugs and in turn poor treatment outcome.…”

“…This pattern of lower success rates among males has been supported by several studies, [7] [57]. Nevertheless one of the studies reported a higher burden among female patients while some others reported no effect of gender on TB treatment outcome [19] [41] [42] [52]. Gender differences in tuberculosis epidemiology may arise either as a consequence of differences in biological functioning or due to differences in the societal roles of men and women.…”

“…Other studies had shown significant association between death and older age [29]- [31] [43], and extremes of age with lower proportions of treatment success [23] [25]. Yet several other studies showed no association between age and treatment outcome of TB [19] [39] [41] [42] [52]. This association with extremes of age may partly be explained by the effect of co-morbidity confounders common at the extremes of age that are likely to worsen the outcome of TB treatment.…”

Prevalence and Factors Associated with Tuberculosis Treatment Success among TB/ HIV Co-Infection in North-East Malaysia

“…Nevertheless, other study in Nigeria found that male patients of TB/HIV co-infection either in rural or urban areas, contributed to successful TB treatment compared to female patients (19). Moreover, in the previous studies conducted among TB patients, female patients were found to have higher contribution to the unsuccessful of TB treatment (11,13).…”