Abstract:
Abstract
Introduction: Provision of antiretroviral therapy has been recommended. However,
tuberculosis is owing to different predisposing factors, which is a continuing predominant
opportunistic infection among human immunodeficiency virus positive children starting
antiretroviral therapy in developing countries.
Objective: The aim was to assess tuberculosis incidence and predictors among human
immunodeficiency virus positive children after starting antiretroviral therapy at Debre-
Markos Referral Hospital, Northwest Ethiopia from March 2005 to April 2017.
Methods: A retrospective cohort study was conducted. Data were entered into EPi-data
3.1 and exported to STATA version 12 statistical package software for analysis. The
incidence rate between groups was compared by log-rank test. Kaplan-Meier was used
to estimate tuberculosis-free survival probability. Cox proportional hazard model was
used to show independent predictors of which a p-value ? 0.05 was inferred statistically
significant.
Result: Thirty-four (9.7%) tuberculosis cases within 1294.7 person-years observation
were found; provided that 2.63 per 100 person-years overall tuberculosis incidence rate.
Mean survival time was 126.4 (95%; (121.1, 131.8) months. Overall tuberculosis-free
survival proportion at the end of the study was 82% (95%CI; 74 to 88%). Being on WHO
clinical stage 3 and 4 (AHR; 3.0, (95% CI); (1.2, 7.7)), a fair and poor adherence (AHR;
4.0, (95%CI; (1.5, 10.8)) a late initiation of ART (AHR; 4.0, (95%CI; (1.5, 10.6)) and ? 6
months duration on ART (AHR; 5.5, (95% CI; (1.5, 20.6)) were predictors of higher
tuberculosis risk.
Conclusion: The incidence rate of tuberculosis was high. WHO clinical stage, a level of
adherence, a timing of antiretroviral therapy initiation, and months on antiretroviral
therapy were identified predictors. A timing of initiation of antiretroviral therapy and the
first six months after starting antiretroviral therapy have to get more focused. Adherence
of HIV-positive children to antiretroviral therapy required attention.
Keywords: Antiretroviral therapy, Children, HIV, Incidence, Tuberculosis, Ethiopia
