Incidence of Tuberculosis and Associated Factors among Patients Attending the HIV Clinic at Felege-Hiwot Referral Hospital, Bahr Dar, Northwest Ethiopia

Abstract

Background: Although a highly active anti retroviral therapy (HAART) reduces the incidence of tuberculosis in the developed world, it remains poorly documented in resource-poor settings including the Amhara Region of Ethiopia.

Objectives: The objective was to assess the incidence and associated risk factors of TB among HIV clients under follow up at Felege Hiwot Referral Hospital (FHRH)

Methods:  A retrospective cohort study with comparison groups of Pre-ART and ART was conducted at FHRH HIV Clinic at Bahir Dar, north-west Ethiopia. The charts of 219 Pre-ART and 219 ART patients were reviewed. The required sample was selected by the systematic sampling technique and was collected from April 1 to 30, 2010. Incidence rates of TB and relative risks were computed for the different comparison groups

Results:  The cumulative incidence of TB was 9.6% among patients on pre-ART chronic HIV care and 3.2% among those receiving HAART (RR =0.33). Patients at the lower WHO clinical stages (Stage I-III) had lesser risk of developing TB compared to patients at WHO clinical stage IV (AOR=0.08). Patients with a baseline CD4 cell count of <200 (AOR= 11.54) and hematocrit level of less than 30 (AOR=18.12) were at higher risk of developing TB. Those who didn’t take Cotrimoxazole prophylaxis had higher risk of developing TB (AOR= 36.24)

Conclusion: Incidence of TB was high among HIV patients who were not receiving ART. Low baseline CD4 cell count, low HCT, advanced WHO clinical stage, and not receiving cotrimoxazole preventive therapy were found to be at a higher risk of developing TB. An early initiation of ART may be considered to reduce the incidence of TB. Frequent checking for anaemia and maximizing the cotrimoxazole preventive therapy is also recommended.