OUTCOME OF DAILY DIRECTLY OBSERVED THERAPY SHORT-COURSE AMONG PULMONARY TUBERCULOSIS AND HUMAN IMMUNODEFICIENCY VIRUS CO-INFECTED PATIENTS IN OYO STATE, NIGERIA

Abstract

Tuberculosis (TB) ranks top among other opportunistic infections in people living with Human immunodeficiency Virus (HIV) which has contributed to high motatlity across age groups in resource constraint settings. The co-existence of Tuberculosis (TB) and is known to present a management challenge. Knowledge of the determinants of outcomes of treatment can help improve care. The main objectives of this study were to determine prevalence of TB/HIV co-infection and treatment outcomes among TB/HIV co-infected patients enrolled on directly observed therapy short-course in Oyo state Nigeria. A cross sectional study design was carried out using patient records from January 2009 to 2010 in 53 functional DOTS centres in Oyo state. The study population consisted of 7905 patients enrolled on anti tuberculosis regimen except for those without HIV results. Information on the treatment cards and other reporting forms were abstracted with the use of data extraction form. Chisquare and logistic regression were used to test the relationship between TB/HIV co-infection and socio-demographic variables, clinical characteristics and treatment outcomes. The mean age of TB/HIV co-infected patients was 37.95± 1.22 compared to the mean age of the TB without HIV patients which was 39.95± 1.66 years. It was seen that there were more females (59%) than males (41%) who were TB/HIV co- infected while for those tuberculosis patients without HIV there were more males (56%) than females (44%) who had TB infection. It was also observed in this study that the treatment outcomes among TB/HIV patients was very poor, Cure (30.2%) and below the 85% WHO standard success rate. The mortality rate was high as (10.6%), treatment failure (4.6%), Default (3.8%), transfer out (3.6%) and treatment completed (47.2%). Majority of the coinfected client received care in the public facilities.The logistic regression showed that co-infected females were 1.227 times more likely to be successfully treated compared to males co-infected patients (Cl= 1.077 - 1.398), co- infected patients that were engaged with work were 2.123 times less likely to be successfully treated (CI= 0.400 - 0.555). ln addition patients receiving anti-tuberculosis treatment in private owned facilities were 1.828 times less likely to be successfully treated compared to patients in government owned facilities (Cl = 0.451 - 0.665). This prevalence of 14.2% for TB/HIV co-infection among tuberculosis patients in this study is similar to findings from related documented studies in Nigeria. This prevalence is still high and therefore calls for collaborative activities and programs in Nigeria on effective treatment TB/HIV co- infected patients as this would really help improve treatment outcomes for TB/HIV patients enrolled on daily DOTS.