Tuberculosis and HIV co-infection in Congolese children: risk factors of death

Mukuku, Olivier; Mutombo, Augustin Mulangu; Kakisingi, Christian; Musung, Jacques Mbaz; Wembonyama, Stanis Okitotsho; Luboya, Oscar Numbi

doi:10.11604/pamj.2019.33.326.18911

Cited by 16 publications

(15 citation statements)

References 28 publications

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“…Poor completion of TB treatment among children aged 0-14 years at MRRH in Uganda was associated with HIV infection; three-quarters of patients with TB completed treatment, compared with only half of TB/HIV coinfected patients. Other studies in Democratic Republic of Congo, Ethiopia, Nigeria, Ghana and Vietnam have identi ed similar results [37][38][39][40][41][42]. There may be multiple factors that in uence this nding: HIV-infected patients may be more prone to depression, lowered family support, and reduced income, which could impact their treatment adherence [43].…”

Section: Discussionmentioning

confidence: 62%

Trends and Treatment Outcomes of Pediatric Tuberculosis at Mbale Regional Referral Hospital, in Eastern Uganda, 2013-2017

Monje¹,

Kadobera²,

Owolabi³

et al. 2021

Preprint

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Background: Childhood tuberculosis (TB) remains a major public health problem in Uganda. Failure to complete TB treatment is associated with development of multi-drug-resistant TB, continued spread of TB, and death. The World Health Organization (WHO) recommends treatment success rates of ≥85% to achieve TB control, but children often have lower success rates due to challenges in case identification and treatment adherence. We assessed trends in childhood TB case notification rates, spatial case distribution, treatment outcomes, and predictors of treatment completion at Mbale Regional Referral Hospital (MRRH) in Eastern Uganda.Methods: We reviewed TB registers and extracted data for patients aged 0-14 years with presumptive TB at MRRH for 2013-2017. We determined the childhood TB case notification rate in the MRRH catchment area, performed a TB case notification rate trend analysis and described spatial TB case distribution. We used logistic regression to identify patient-related and hospital-related factors associated with completion of TB treatment at MRRH among HIV-positive and HIV-negative patients. Results: We identified 331 TB case notifications among children <15 years. TB case notification rates declined from 6.6/100,000 in 2013 to 2.2/100,000 in 2017 [odds ratio (OR)=0.81; 95% confidence intervals (CI)=0.58-1.1]. Mbale District recorded the highest TB case notification rate (79/100,000), and Kapchorwa District recorded the lowest TB case notification rate (3.8/100,000). Completion rates varied from 35% to 80%. Of the 331 patients, 167 (50%) completed TB treatment. In logistic regression, 142 (75%) of 189 HIV-negative TB patients completed TB treatment compared to 25 (54%) of 46 HIV-positive TB patients (OR=2.5; 95%CI=1.3-4.9). Seventy-four (63%) of 117 patients in the facility-based model and 93 (79%) of patients in the community-based model completed TB treatment (OR=0.47; 95% CI=0.26-0.83).Conclusions: Only half of childhood TB patients completed treatment, well below the WHO target of ≥85% completion. Although TB completion was associated with treatment model and HIV-negative status, neither HIV-positive nor HIV-negative patients had acceptable completion rates. MRRH should strengthen HIV treatment services among childhood TB patients by engaging peer groups and trusted community leaders to provide education on the importance of completing TB treatment.

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Section: Discussionmentioning

confidence: 62%

Trends and Treatment Outcomes of Pediatric Tuberculosis at Mbale Regional Referral Hospital, in Eastern Uganda, 2013-2017

Monje¹,

Kadobera²,

Owolabi³

et al. 2021

Preprint

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“…In fact, on previous multicenter observational research result indicated, infections other than TB contribute in one round infection 54-57 cells/mm3 substantially reduction of CD4 count[34]. Which directly favors reactivation of Mycobacterium tuberculosis bacilli to change active TB infections[21, 34,37]. In this study, not started isoniazid (INH) was significantly associated with the incidence of pulmonary tuberculosis.…”

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confidence: 60%

Time to Develop Pulmonary Tuberculosis and Predictors Among HIV Infected Children Receiving Anti-Retroviral Therapy in Assosa and Pawe General Hospitals, North West Ethiopia 2020

bizuneh¹,

Boneya²,

Dessie³

2020

Preprint

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Recently, pulmonary tuberculosis (PTB) incidence is a serious co-infection and an emerging global concern for children living with human immune deficiency virus (HIV). However, the incidence of PTB among adult HIV patients is exhaustively studied; the incidence of PTB among children on ART is overlooked. This research provides invaluable time based relevant actionsclues.Objective:- Hospital-based retrospective cohort study was conducted among 359 HIV infected children those registered on ART since 2009-2018. Time to develop PTB defined as the time from enrollment for ART care until the development of PTB. The proportional hazard assumption was checked for each variable and no variable was found with Schoenfeld test <0.05. Variables with P-value <0.25 at bivariate Cox regression analysis were entered into the multivariable Cox model. Multivariable Cox regression model with 95%CI and AHR used to identify significant predictor. Result:-Totally 359 HIV infected children followed and produced 686.5 Person per Years of observation (PYOs) with minimum and maximum follow up time on ART was 0.34 & 5.1 years, respectively. The median age of the children was 9 (SD±3.78) years. The overall incidence density of PTB was 7.2 Person/100years in 95%CI (5.52--- 9.24).Notably being age group >= 11 years (AHR=5.1 95% CI 1.4--18.), who stage 3&4 (AHR= 3.4 times increase the risks of PTB developed was compared WHO clinical stage 1& 2 (AHR=3.4 95%CI: 1.2-9.7). Being sever underweight (AHR=3.2 95%CI: 1.3--7.8), not started INHAHR =2.8, 95%CI: 1.1 -7.2) and having previous opportunistic infections (AHR= 2.34 95%CI: 1.3--4.1) significantly associated with PTB incidence. Conclusion:-The incidence of PTB in HIV infected children were found higher as compared with evidence from previous findings. Strengthening intensified screening of INH and therapeutic feeding needs for risk children highly recommended.

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“…This exploratory analysis had limited power and did not determine a statistically significant difference in the case-fatality rate among the two populations. In published studies, TB manifestations have been shown to be more severe and progression to death more rapid among CLHIV compared to those living without HIV, with overall high rates of mortality, specifically amongCLHIV under the age five years [ 24 ] and in those with poor nutritional status [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

HIV matters when diagnosing TB in young children: an ancillary analysis in children enrolled in the INPUT stepped wedge cluster randomized study

Powell

Denoeud-Ndam²,

Herrera

et al. 2023

BMC Infect Dis

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Background Children under age five years, particularly those living with HIV (CLHIV), are at risk for rapid progression of tuberculosis (TB). We aimed to describe TB clinical presentations, diagnostic pathways and treatment outcomes in CLHIV compared to children without HIV in Cameroon and Kenya. Methods This sub-analysis of a cluster-randomized trial evaluating the integration of pediatric TB services from May 2019 to March 2021 enrolled children age < 5 years with TB. We estimated the HIV infection rate with 95% confidence interval (CI). We compared TB clinical presentations, diagnostic pathways and treatment outcomes in CLHIV and children without HIV. Finally, we investigated whether HIV infection was associated with a shorter time to TB diagnosis (≤ 3 months from symptoms onset) after adjusting for covariates. Univariable and multivariable logistic regression analysis were performed with adjusted odds ratios (AORs) presented as measures of the association of covariates with HIV status and with shorter time to TB diagnosis. Results We enrolled 157 children with TB (mean age was 1.5 years) and 22/157 (14.0% [9.0-20.4%]) were co-infected with HIV. CLHIV were more likely to initially present with acute malnutrition (AOR 3.16 [1.14–8.71], p = 0.027). Most TB diagnoses (140/157, 89%) were made clinically with pulmonary TB being the most common presentation; however, there was weak evidence of more frequent bacteriologic confirmation of TB in CLHIV, 18% vs. 9% (p = 0.067), due to the contribution of lateral-flow urine lipoarabinomannan to the diagnosis. HIV positivity (AOR: 6.10 [1.32–28.17], p = 0.021) was independently associated with a shorter time to TB diagnosis as well as fatigue (AOR: 6.58 [2.28–18.96], p = 0.0005), and existence of a household contact diagnosed with TB (AOR: 5.60 [1.58–19.83], p = 0.0075), whereas older age (AOR: 0.35 [0.15–0.85], p = 0.020 for age 2–5 years), night sweats (AOR: 0.24 [0.10–0.60], p = 0.0022) and acute malnutrition (AOR: 0.36 [0.14–0.92], p = 0.034) were associated with a delayed diagnosis. The case fatality rate was 9% (2/22) in CLHIV and 4% (6/135) in children without HIV, p = 0.31. Conclusions These results altogether advocate for better integration of TB services into all pediatric entry points with a special focus on nutrition services, and illustrate the importance of non-sputum-based TB diagnostics especially in CLHIV. Trial registration NCT03862261, first registration 05/03/2019.

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Tuberculosis and HIV co-infection in Congolese children: risk factors of death

Cited by 16 publications

References 28 publications

Trends and Treatment Outcomes of Pediatric Tuberculosis at Mbale Regional Referral Hospital, in Eastern Uganda, 2013-2017

Trends and Treatment Outcomes of Pediatric Tuberculosis at Mbale Regional Referral Hospital, in Eastern Uganda, 2013-2017

Time to Develop Pulmonary Tuberculosis and Predictors Among HIV Infected Children Receiving Anti-Retroviral Therapy in Assosa and Pawe General Hospitals, North West Ethiopia 2020

HIV matters when diagnosing TB in young children: an ancillary analysis in children enrolled in the INPUT stepped wedge cluster randomized study

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Tuberculosis and HIV co-infection in Congolese children: risk factors of death

Cited by 16 publications

References 28 publications

Trends and Treatment Outcomes of Pediatric Tuberculosis at Mbale Regional Referral Hospital, in Eastern Uganda, 2013-2017

Trends and Treatment Outcomes of Pediatric Tuberculosis at Mbale Regional Referral Hospital, in Eastern Uganda, 2013-2017

Time to Develop&nbsp;Pulmonary Tuberculosis&nbsp;and Predictors&nbsp;Among HIV Infected Children Receiving Anti-Retroviral Therapy&nbsp;in&nbsp;Assosa and&nbsp;Pawe General Hospitals, North West Ethiopia 2020

HIV matters when diagnosing TB in young children: an ancillary analysis in children enrolled in the INPUT stepped wedge cluster randomized study

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Product

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Time to Develop Pulmonary Tuberculosis and Predictors Among HIV Infected Children Receiving Anti-Retroviral Therapy in Assosa and Pawe General Hospitals, North West Ethiopia 2020