Medicina Pulmonar e Respiratória

Time to develop Pulmonary Tuberculosis and Predictors among HIV Infected Children Receiving Anti-Retroviral Therapy in Assosa and Pawe General Hospitals, North West Ethiopia: A Retrospective Cohort Study

Abstract

Fassikaw Kebede Bizuneh*, Dube Jara Boneya, Abebe Abate Dessie

Introduction: 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 provide indispensible time-based relevant interventions clues.

Objective: Hospital-based retrospective cohort study was conducted among 359 HIV infected children, those registered on ART since 2009-2018. Time to develop PTB was defined as the time from enrollment for ART care until the development of PTB. Survival analysis was used and the proportional hazard assumption was checked for each variable and no variable was found with Schoenfield test <0.05. Variables with P-value <0.25 in bivariate Cox regression analysis were entered into the multivariable Cox model. Multivariable Cox regression model with 95%CI and AHR was used to identify the significant predictors.

Materials and Methods: We conducted facility based retrospective cohort study from January 1/2009 to December 31, 2018 at Assosa and Pawe general hospitals in Benishangule Gumuz region. Both hospitals are located in North West Ethiopia; this region is one of the regional states established in 1994 by the constitution of Ethiopia. It is located in the western part of Ethiopia between 34° 10’N and 37° 40’E; and in the latitude 09° 17’N and 12° 06’ N. Assosa is the capital city of the region, it is located at a distance of 659 km in the west, and Pawe is located a distance from 565 km from in North West direction of Addis Ababa.

Results: This included individual records of 359 HIV-infected children initiated ART with in the period of January 1st 2009 to December 31 2018. During the follow-up period, totally 686.5 Persons per Year of observation (PYOs) were produced with minimum and maximum follow-up time on ART was 0.34 & 5.1 years, respectively. The overall incidence rate of PTB was found 2.78 (95% CI: 2.4-5.76) per 100 child-years of observation. Age group >= 11 years (AHR=5.1 95%CI: 1.4-18), advanced Who stage III&IV (AHR=3.4 95%CI: 1.2-9.7), Being severed underweight (AHR=3.2 95%CI: 1.3-7.8), Not started Isoniazid preventive therapy (INH) (AHR=2.8, 95%CI: 1.1-7.2) and having previous opportunistic infections (OIs) (AHR= 2.34 95%CI: 1.3-4.1) were significantly associated with PTB occurrence.

Conclusion: The findings of this study indicated, the incidence rate of PTB among HIV infected children remains has high health impact. Concerning associated factors such as advanced who stage III& IV, being severe underweight, not started, isoniazid prophylaxis, and previous OIs is significantly associated with PTB incidence.