Time To Death And Its Predictors Among Tb-Hiv Co-Infected Patients At Art Health Facilities In Adeaberga District, West Shewa, Oromia, Ethiopia

Abstract

Introduction: - TB is the most frequent life-threatening Opportunistic Infection and a leading cause of death among HIV infected people. TB remains the leading cause of mortality among people living with HIV, despite substantial scale-up of ART, accounting for 30% of the AIDS related deaths reported in 2019. Objective: - To assess Time to death and its predictors among TB-HIV co-infected patients at ART Public health facilities, in Adeaberga woreda, West Shewa, Oromia, Ethiopia. Method: Retrospective cohort study was used by reviewing registers of randomly selected 308 TB-HIV co-infected patients enrolled from May, 2018 to April, 2022. The collected data were entered into Epi-info version 7.2.2.6 and exported to SPSS version 23 for analysis. Cox Proportional Regression Model was used to identify independent predictors of time to death. In bivariable analysis, P-value ≤ 0.25 was used to identify candidate variables for multivariable analysis. The 95% CI of hazard ratio (HR) with respective P-value <0.05 was used to declare significance in the final model. Kaplan Meir curve was used for the estimation of time to death among the patients. Result: A total of 308 study participants were followed during the median study period of 176 days (Interquartile Range 114 in days). The overall incidence rate of death was 1.40 cases per 1000 person days (95% CI: 1.34, 1.48). The Cox Proportional Hazard regression model analysis showed that female sex (AHR=1.94, 95%CI: 1.03, 3.65), BMI<18.5kg/m² (AHR=2.64, 95%CI: 2.19, 3.19), not disclosed HIV status (AHR=2.99, 95%CI: 1.02, 8.90), bedridden functional status (AHR=9.69,95%CI:1.76,53.17),CD4<200cells/mm³(AHR=1.14,95%CI:1.12,4.37),being Pulmonary type of TB (AHR=1.11,95%CI:1.01,8.88) and At least three Opportunistic Infection other than TB (AHR=3.34,95%CI:1.39,8.003) were significant predictors of high mortality rate at 95% CI of hazard ratio, P-value < 0.05 level of significance. Conclusion and Recommendation: The overall incidence rate of death was 1.40 cases per 1000 person days. The independent predictors were female sex, BMI <18.5kg/m², bedridden functional status, not disclosed HIV status, CD4<200 cells/mm³, Pulmonary TB type and Opportunistic Infection At least three other than TB. Therefore, ART and TB clinic Providers should give more attention to address cause of early death among TB-HIV co-infected patients.