Epidemiological profile, treatment outcomes and factors associated with unfavorable treatment outcomes among patients co-infected with Tuberculosis and Human Immunodeficiency Virus in the Centrale Health Region in Togo, 2008 – 2017

Abstract

Introduction: Co-infection with Tuberculosis and Human Immunodeficiency Virus (TB/HIV) is highly lethal and Africa hosts 74% of cases. In Togo, the prevalence of TB/HIV co-infection was 22% in 2016 with a 42% mortality among the TB/HIV co-infected cases. There is limited data on TB/HIV co-infection in Centrale health region to inform control and commitment efforts towards end TB by 2030. We aimed to describe epidemiological characteristics, treatment outcomes and identify factors associated with unfavorable outcomes among TB/HIV co-infected cases. Methods: We conducted a descriptive analysis of secondary data on TB cases recorded in the four Centers of Diagnosis and Treatment (CDTs) of the Togolese Centrale health region from 2008 to 2017. Socio-demographical, clinical and treatment data were collected on a designed questionnaire by reviewing all TB management tools of the four CDTs. We subsequently entered data in Epi-Info-7 and calculated means, ratio and proportions for descriptive analysis. In multivariate analysis, logistic regression was performed to obtain Adjusted Odd Ratio (AOR), 95% Confidence Interval (CI) and p-value to identify factors associated with unfavorable outcomes. Results: Over the period, 1,448 patients were screened for HIV among 1,825 TB patients recorded. Overall, TB/HIV prevalence was 30.87% (447/1448) range 43.8% in 2008 to 27.6% in 2017 (p=0.01). The mean age of TB/HIV patients varied from 28.80±7.70 years in 2008 to 33.48±8.11 years in 2017. Female to Male sex ratio varied from 9.7 in 2008 to 2.5 in 2017. Pulmonary TB form cases accounted for 94.41% (422/447) of which 74.41% (314/422) were smear positive (SPT+) and 25.59% (108/422) were smear negative, while extra-pulmonary form cases represented 5.59% (25/447). The proportion of TB/HIV patients on Antiretroviral Treatment (ART) varied from 5.25% (2/32) in 2008 to 94.29% (33/35) in 2017. Lost to follow up patients represented 1.57% (7/447) while treatment success rate varied from 62.29% in 2008 to 82.00% in 2017. Case fatality rate decreased from 34.48% in 2008 to 23.53% in 2017. Smear-positive TB (AOR=2.11, 95% CI (1.21-3.60)), TB treatment initiation in the second quarters of the year (AOR=1.71, 95% CI (1.03-2.85)) and having been taken care of between 2015 and 2017 (AOR=1.90, 95% CI (1.14 – 3.12)) were independently associated with unfavorable outcome. When stratified by type of outcome, the absence of ART (AOR=2.62, 95% CI (1.46 – 4.69) were associated with deaths. Conclusion: TB/HIV co-infection affected young people particularly women with high mortality. The TB form, period of treatment initiation and lack of HIV care influenced treatment outcomes. Systematic HIV screening and ART earlier initiation, practice of DOTS whether based on family or based on caregivers for each patient and caregivers training on TB/HIV co-infection management are necessary to improve patients' survival.