Incidence and determinants of tuberculosis among HIV-positive individuals in Addis Ababa, Ethiopia: A retrospective cohort study

Objective: To assess the incidence and determinants of tuberculosis (TB) among HIV-positive individuals in selected health facilities of Addis Ababa, Ethiopia, during the period January 2013 to December 2018. Methods: Data were collected from the records of 566 HIV-positive individuals. A retrospective cohort study design was employed. Data were entered into Epi Info 7 and analyzed using IBM SPSS Statistics version 20. TB incidence density was determined per 100 person-years. Time-to-event distributions were estimated using Kaplan-Meier estimates. Survival curves and hazards across different categories were compared using log-rank tests. Determinants were identified using the Cox proportional hazards model. The hazard ratio (HR) and 95% confidence interval (CI) were computed. A p-value <0.05 in the multivariate analysis was considered statistically significant. Results: A total of 566 HIV-positive individuals were followed for 2140.08 person-years, giving a TB incidence density rate of 6.82/100 person-years (146, 25.8%). The highest incidence was observed within the first year of follow-up. Independent determinants were large family size (adjusted HR (AHR) 1.783, 95% CI 1.113-2.855), lower baseline CD4 (AHR 2.568, 95% CI 1.602-4.116), and baseline body mass index <18.5 kg/m(2) (AHR 1.907, 95% CI 1.530-2.690). Being enrolled in antiretroviral treatment (AHR 0.066, 95% CI 0.045-0.98) and taking isoniazid prophylaxis treatment (AHR 0.202, 95% CI 0.108-0.380) had a protective effect. Conclusions: TB is still a major cause of morbidity among HIV-positive individuals. Early HIV diagnosis, enrollment on antiretroviral treatment, and isoniazid prophylaxis treatment should be considered to decrease the TB risk. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.