title: Profile, Outcomes, and Determinants of Unsuccessful Tuberculosis Treatment Outcomes among HIV-Infected Tuberculosis Patients in a Nigerian State.
abstract: Background. Few studies have evaluated the rate of tuberculosis (TB)/human immunodeficiency virus (HIV) coinfection and the determinants of its treatment outcomes in Africa. We aimed to determine the predictors of unsuccessful treatment outcomes in HIV-infected tuberculosis patients in Nigeria. Methods. A retrospective cohort study design was used to assess adult TB/HIV patients who registered for TB treatment in two health facilities in Ebonyi State, Southeast Nigeria, between January 2011 and December 2012. Predictors of unsuccessful treatment outcomes were determined using multivariable logistic regression analysis. Results. Of 1668 TB patients, 342 (20.5%) were HIV coinfected. Of these, 195 (57%) had smear-negative pulmonary TB and 11 (3.2%) had extrapulmonary TB. Overall, 225 (65.8%) patients achieved successful outcomes, while 117 (34.2%) had unsuccessful outcomes. The unsuccessful treatment outcomes were due to "default" (9.9%), "death" (19%), "treatment failure" (1.5%), and "transferring out" (3.8%). Independent determinants for unsuccessful outcomes were receiving care at a public facility and noninitiation of antiretroviral therapy. Conclusion. There is need for the reevaluation of the quality of public sector treatment services provided for TB/HIV patients as well as further expansion of TB/HIV collaborative activities in rural areas, and interventions to reduce mortality and default rates among TB/HIV patients are urgently needed in Nigeria.
authors.affiliation: Centre for Development and Reproductive Health, Enugu, Enugu State 400001, Nigeria.
authors.forename: Daniel Chukwunweolu
authors.initials: DC
authors.lastname: Oshi
authors.affiliation: Centre for Development and Reproductive Health, Enugu, Enugu State 400001, Nigeria.
authors.forename: Sarah Nakalema
authors.initials: SN
authors.lastname: Oshi
authors.affiliation: National Tuberculosis and Leprosy Control Programme, Ministry of Health, Abakaliki, Ebonyi State 480001, Nigeria.
authors.forename: Isaac
authors.initials: I
authors.lastname: Alobu
authors.affiliation: Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State 480281, Nigeria.
authors.forename: Kingsley Nnanna
authors.identifier: 0000-0002-1974-8735
authors.initials: KN
authors.lastname: Ukwaja