Treatment Outcome of Tuberculosis in HIV Positive and Negative Patients in Selected Hospitals in the Accra Metropolis.

Abstract

Introduction: Tuberculosis is currently causing more deaths than HIV. Approximately 1.8 million people died from TB; of which 0.4 million were HIV positive. Ghana is one of the 30 high burden TB/HIV countries with one of the highest TB/HIV incidence rates. The case fatality rates of tuberculosis in Ghana has stagnated at 10percent over the past few years and is unacceptably high. The prognosis of treatment in TB/HIV co-infected patients is poor compared to TB patients without HIV infection. This study investigated the outcomes of TB treatment and predictors of mortality among TB/HIV co-infected patients and TB patients without HIV infection. Methods: A three-year (2013 to 2015) retrospective cohort study was conducted at La General Hospital and Achimota Hospital in the Greater Accra Region of Ghana. A pre-tested data extraction tool was used to extract relevant information. A total of 521 observations were analysed using STATA 14. Multinomial logistic regression was used to determine the difference in TB treatment outcome between HIV positive and negative patients. Survivor function and survival curves were estimated with Kaplan-Meier analysis. Cox proportional hazard regression model was used to determine predictors of mortality. All tests were two-tailed and statistical significance was set at 0.05. Results: A significant increase in the risk (aRR 5.85, 95percentCI 2.83-12.09) of death relative to treatment success was observed among HIV positive patients compared to those without HIV infection. The cumulative probability of survival was 0.73 for TB/HIV patients and 0.93 for HIV negative patients (log rank test, p-value <0.001). More than half of deaths in the study population occurred in the initial phase of treatment. Predictors of death among all TB cases were, baseline weight (adjusted HR = 0.96 95percent CI 0.192-0.99) and HIV negative status (adjusted HR= 0.29 95percentCI 0.16-0.53). Among TB/HIV co-infected patients, not taking CPT during treatment was associated with an adjusted hazard ratio of 3.39 (95percent CI 1.35-8.52). Only 3.9percent of TB/HIV co-infected patients were given ART during TB treatment. Conclusions: These results suggest that interventions focussed on improving the outcomes of TB patients with low body weight and HIV infection could reduce TB mortality in our settings.