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

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