Incidence of death and its predictors among TB/HIV coinfected adult patients receiving anti-retroviral therapy at Gambelia referral hospital, Southwest Ethiopia, 2022

Abstract

Background: In patients who have tuberculosis and the human immunodeficiency virus, Tuberculosis is the most prevalent opportunistic illness and the main cause of death. However, little is currently, the time to death and its predictors are known, particularly among individuals with coinfection in the study area. Therefore, this study was aimed fill this gap in the region.

Objective: To assess the incidence of death and its predictors among tuberculosis patients and humans immunodeficiency virus coinfected adult patients receiving antiretroviral therapy in Gambella Referral Hospital, Southwest Ethiopia, 2022.

Methods: This Retrospective cohort study included 320 coinfected adult patients on antiretroviral therapy from June 2017 to June 2022. Data were extracted from the document by using a structured checklist adapted and prepared on the basis of the charts. Death is the event, whereas not having experienced death is censored. The data were entered in to Epi-data version 3.1 and then export to STATA version 14. Kaplan- Meier curve and log rank tests were used to compare the survival curves and estimate survival time. Cox regression model was used to identify significant predictors of death. A Cox-Snell residual plot was used to measure the Cox model goodness of fit.

Results: The cumulative mortality rate for the 320 coinfected individuals that were monitored was 14.7%, with an incidence rate of 6.7 deaths per 1000 person-months (95% CI: 5.0-8.9). Individuals with low adherence to ART who are female (AHR 2.1, 95%CI: 1.05-4.21). In contrast, non-users of cotrimoxazole treatment (AHR = 4.03, 95%CI: 1.99-. The risk of death was greater for those with a viral load > 1000 copes/ml (AHR: 3.18, 95%CI: 1.19-8.52).

Conclusion and recommendation: In comparison to Ethiopia's 2021 death rate, the study area's mortality incidence rate was high. There was a higher risk of death for ART-using female patients, those with poor ART adherence, those with an opportunistic infection other than tuberculosis, those with a viral load value between 50 and 1000 copies per milliliter and more than 1000 copies per milliliter, and those who did not use cotrimoxazole prophylactic therapy. Therefore, extensive monitoring and counseling can be beneficial for patients with virus loads greater than 1000 copies/ml, non-CPT users, females, and poor ART adherence.

Keywords: Anti-retroviral therapy; Co-infection; Incidence of death; Mortality; TB/HIV.

Fig. 1

ART regimens given for TB/HIV co-infected adult patients on ART at Gambella Referral Hospital, 2022

Fig. 2

Kaplan–Meier survival estimates based on their OI other than TB during the follow up time among TB/HIV co-infected adult patients on ART in Gambella Referral Hospital, 2022

Fig. 3

Kaplan–Meier survival estimates based on their CPT during the follow up time among TB/HIV co-infected adult patients on ART in Gambella Referral Hospital, 2022

Fig. 4

Kaplan–Meier survival estimates based on their sex during the follow up time among TB/HIV co-infected adult patients on ART in Gambella General Hospital, 2022

Fig. 5

Kaplan–Meier survival estimates based on their ART adherence during the follow up time among TB/HIV co-infected adult patients on ART in Gambella Referral Hospital, 2022

Fig. 6

Kaplan–Meier survival estimates based on their viral load during the follow up time among TB/HIV co-infected adult patients on ART in Gambella Referral Hospital, 2022

Fig. 7

Cox- Snell residual overall goodness of fit test result among TB/HIV co-infected adult patients on ART in Gambella referral hospital, 2022