International Journal of Infectious Diseases
Background: To provide efficient, equitable, patient-centered, and evidence-based services to people living with HIV/AIDS (PLWH), it is critical for the intervention programs to understand the nature of barriers to effective treatment and additional risks faced by PLWH with tuberculosis (TB) coinfection. This study analyzes two aspects of TB coinfection in PLWH: (a) variation in TB/HIV coinfection by demographic and clinical characteristics of patients; and (b) risks of negative outcomes such as death, loss to follow up, and higher viral load among PLWH with TB coinfection compared to those without such coinfection.
Methods and materials: This quantitative study used data on 49,460 PLWH on ART from 241 HIV/AIDS clinics in two provinces of Democratic Republic of Congo, Haut-Katanga and Kinshasa. Chi-square and logistic regression analyses were performed. Three separate logistic regression analyses were performed to estimate the impact of TB status on three dichotomous dependent variables: death, LTFU (vs. in care or transferred out), and viral load above 1,000 copies per ml of blood, after controlling for other variables.
Results: Significantly higher proportions of patients with TB/HIV coinfection were males (4.5% vs. 3.3%); new patients rather than transferred-in (3.7% vs. 1.6%) resided in the Kinshasa province rather than Haut-Katanga (4.0% vs. 2.7%) and were in an urban health zone (3.9%) and semi-rural (3.1%) rather than rural (1.2%) health zone. The logistic regression models showed that after controlling for other demographic and clinical variables, TB/HIV coinfection raised the risk of death (AOR, 2.26; CI, 1.94–2.64) and loss to follow up (AOR, 2.06; CI, 1.82 to B/HIV coinfection lowered the odds of viral load suppression (VLS) below 1,000 copies per ml of blood (AOR, 0.58; CI, 0.46–0.74).
Conclusion: TB/HIV coinfection raises the risk of negative outcomes such as death, loss to follow up, and inability to have viral load suppressed below 1,000 copies per ml. HIV clinics in DRC and other African countries may consider these findings when customizing their interventions to improve HIV care and reduce disparities in PLWH.
Shah, Gulzar H., Raimi Ewetola, Gina D. Etheredge, L. Maluantesa, Kristie C. Waterfield, L.-K. Lukusa.
"TB/HIV coinfection and patient outcomes: Evidence from 241 clinics in the Democratic Republic of Congo."
International Journal of Infectious Diseases, 101 (S1): 293: Elsevier.
doi: 10.1016/j.ijid.2020.09.767 source: https://www.sciencedirect.com/science/article/pii/S1201971220314831?via%3Dihub#!