“Universal test and treat” program reduced TB incidence by 75% among a cohort of adults taking antiretroviral therapy (ART) in Gurage zone, South Ethiopia

Abstract

Background: Tuberculosis (TB) remains the leading cause of morbidity and mortality in peoples living with HIV and at least 25% of deaths are attributed to TB. Many countries implement the Universal Test and Treat (UTT) program for HIV, which is believed to reduce the incidence of TB. However, there are limited studies that evaluate the impact of UTT on TB incidence. Therefore, by recruiting a cohort of ART users in the "UTT" and "differed treatment" programs, we aim to measure the effect of the UTT program on TB incidence. Objective: To measure the effect of "UTT" program on TB incidence among a cohort of adults taking antiretroviral therapy (ART) in Gurage Zone, South Ethiopia. Methods: A retrospective cohort study was conducted through record review over 5 years (2014-2019) in public health facilities in Gurage Zone. Three hundred eighty-four records were randomly selected and reviewed using a standardized structured checklist. Data was entered using Epi Info™ Version 7 and analyzed by STATA. A generalized linear model with binomial link function was fitted to measure the adjusted incidence density/incidence rate ratio and to identify predictors of incidence difference between the two programs. Results: During the follow up period, 39 incident TB cases were identified with an overall incidence rate of 4.79/ 100 person-year (PY). TB incidence was significantly lower in the UTT cohort (IR = 2.10/100 PY) in comparison to the differed program cohort (IR = 6.23/100 PY). The adjusted incidence rate ratio (AIRR) of TB among patients enrolled in the UTT program was; 0.25 (95% CI = 0.08-0.70). Thus, there was a reduction of TB incidence by 75% in the UTT program compared to differed program. In addition, IPT (isoniazid preventive therapy) use (AIRR = 0.35 (95% CI = 0.22-0.48)), WHO Stage I and II (AIRR = 0.70 (95% CI = 0.61-0.94)) and higher base line CD4 count (AIRR = 0.96 (95% CI = .94-0.99)) significantly reduced the incidence of TB. However, treatment failure increase the incidence (AIRR = 5.8 (95% CI = 1.93-8.46)). Conclusion: TB incidence was significantly reduced by 75% after UTT. Therefore, intervention to further reduce the incidence has to focus on strengthening UTT program and IPT.

Incidence and predictors of Tuberculosis among patients enrolled in Anti-Retroviral Therapy after universal test and treat program, Addis Ababa, Ethiopia. A retrospective follow -up study

“…found to be 4.84 per 100 PY of observation. This finding is in line with studies conducted in the Gurage zone, Ethiopia (4.79cases per 100 PY), Arba Minch, Ethiopia (5.36 cases per 100 PY), and Tanzania (4.4 cases per 100 PY) [16][17][18]. However, it is higher than the studies from Brazil and the USA which reported the incidence of TB to be (2.28 cases per100 PY), and (0.7cases per 100PY), respectively [19,20].…”

“…This variation could be explained by the difference in the study period. This means our study was done after the universal test and treat program and this might decrease the incidence [ 16 ] as a result of early initiation, strong follow up, and proper implementation in TB/HIV care service. Moreover, creation of better awareness regarding the prevention of TB/HIV co-infection might also contribute to the low incidence [ 22 , 23 ].…”

“…In this study, lost to follow-up was defined as an HIV-positive patient missing an ART appointment for one to 3 months. Additionally, adherence was classified as good, fair, or poor, according to the percentage of drug dosage calculated from a monthly total dose of ART drugs; hence, good was reported if equal to or greater than 95% or ≤ 3 doses missing per month, fair if 85–94% or 4–8 dose missing per month, or poor if less than 85% or ≥ 9 doses missing per month [ 15 ]. Furthermore, low hemoglobin level was defined as hemoglobin level less than to10 g/dl.…”

“…Ethiopia started the UTT program in 2016 in order to change the distribution of HIV infection [ 15 ]. After initiation of UTT program, different intervention strategies have been implemented among PLHIV to reduce the occurrence of TB/HIV co-infection and overcome TB related morbidity and mortality among PLHIV.…”

The effect of the Universal Test and Treat policy uptake on CD4 count testing and incidence of opportunistic infections among people living with HIV infection in Cameroon: a retrospective analysis of routine data

“…Few studies have reported the incidence of IO under the UTT policy. In Ethiopia, a reduction of TB incidence by 75% in the UTT programme compared to the deferred programme was observed [ 17 ]. The WCA are once more trailing the rest of SSA in documenting their experiences in implementing UTT.…”