“Incidence And Predictors Of Extra Pulmonary Tuberculosis Among Adult Patients Enrolled On Art In Ambo Town Public Hospitals, 2024”

Abstract

Background: Extra-pulmonary tuberculosis is a public health problem among HIV positives compared to the general population. Ethiopia is among the 30 high TB and TB/HIV burden countries globally. The occurrence of EPTB in HIV patients can lead to increased morbidity and mortality rates, as well as a high risk of TB treatment failure and drug resistance. Objective: This study aimed to assess the incidence and predictors of extra pulmonary tuberculosis among people living with HIV in public hospitals, Ambo, Ethiopia, from 01 January 2018 up to 31 December 2022. Methods: A retrospective cohort study design was employed based on data collected from 582 HIV positive individuals. Data were entered using Epi-Info version 7.1 and analyzed by SPSS version 20. The incidence rate was determined per 100 person-years. Kaplan-Meier estimates used to estimate survivor EPTB free survival and the hazard function, whereas log rank tests used to compare survival curves and hazard across different categories. Variables having p-value ≤0.25 in the bi-variable analysis were identified fore multivariable Cox proportional hazard regression model. P-value <0.05 in the multivariable analysis was considered statistically significant. Results: Five hundred fifty four HIV positive patients were followed for 2674.92 person time years. Among all, 29 (5.23%) developed EPTB with an incidence density of 1.08 per 100 person years (95% CI: 0.75 - 1.56). The most frequent forms of EPTB occurred were lymph nodes (TB Lymphadenitis TB 17(58.62%), followed equally by pleural TB 24.14 %( 7). In multivariable Cox regression analysis, baseline WHO stage WHO stage IV (AHR = 36.47, 95%CI = 2.93 - 454), Not took IPT (AHR = 12.97, 95% CI = 2.28 - 73.90), Not received CPT (AHR = 8.91, 95% CI = 2.07 - 38.31), History of TB (AHR=81.90, 95% CI 6.86 - 978.37), Poor adherence (AHR = 9.75, 95% CI = 2.14 - 44.37), Fair Adherence (AHR = 8.05 95% CI : 1.17 - 55.53), No disclosure sero-status (AHR = 15.08; 95% CI : 2.12 - 107.07), were some of independent predictor of EPTB. Conclusion and Recommendation: Extra pulmonary tuberculosis (EPTB) is a common opportunistic infection among people living with HIV, particularly affecting lymph nodes and pleura. EPTB typically develops within 5 years of HIV diagnosis, with most cases occurring early in follow-up. ART clients should be educate on the importance of ART adherence and prophylactic treatments (CPT, IPT), and provide information on the risks of not disclosing HIV status. Also Offer counseling and support to those facing difficulties with ART adherence.