title: Predictors of mortality in a cohort of tuberculosis/HIV co-infected patients in Southwest Ethiopia.
abstract: BACKGROUND
  Tuberculosis/HIV co-infection is a bidirectional and synergistic combination of two very important pathogens in public health. To date, there have been limited clinical data regarding mortality rates among tuberculosis/HIV co-infected patients and the impact of antiretroviral therapy on clinical outcomes in Ethiopia. This study assessed the incidence and predictors of tuberculosis/HIV co-infection mortality in Southwest Ethiopia.
  
  
  METHODS
  A retrospective cohort study collated tuberculosis/HIV data from Jimma University Teaching Hospital for the period of September 2010 and August 2012. The data analysis used proportional hazards cox regression model at P value of ≤ 0.05 in the final model.
  
  
  RESULTS
  Fifty-five (20.2 %) patients died during the study period and 272 study participants contributed 3 082.7 person month observations. Factors including: being aged between 35-44 years (AHR = 2.9; 95 % CI: 1.08-7.6), being a female sex worker (AHR = 9.1; 95 % CI: 2.7-30.7), being bed ridden as functional status (AHR = 3.2; 95 % CI: 1.2-8.7), and being at World Health Organization HIV disease stages 2 (AHR = 0.2; 95 % CI: 0.06-0.5), 3(AHR = 0.3; 95 % CI: 0.1-0.8) and 4(AHR = 0.2; 95 % CI: 0.04-0.55) were significant predictors of mortality for tuberculosis/HIV co-infected patients.
  
  
  CONCLUSIONS
  Contrary to our expectations, the World Health Organization (WHO) HIV disease stage 1 was found to be a significant predictor of mortality. Higher mortality rates were observed in WHO disease stage 1 patients compared to patients in stages 2, 3 and 4. The current study also confirmed and reaffirmed known significant predictors of the mortality for tuberculosis/HIV co-infected patients including being 35-44 years, being a female sex worker and being bed ridden functional status. The occurrence of high death rate among tuberculosis/HIV co-infected cases needs actions to reduce this poor outcome.
authors.affiliation: Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia.|Discipline of Public Health, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia.
authors.forename: Hailay
authors.initials: H
authors.lastname: Gesesew
authors.affiliation: Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia.|School of Statistics and Mathematics, Faculty of Science, University of Alberta, Edmonton, Canada.
authors.forename: Birtukan
authors.initials: B
authors.lastname: Tsehayneh
authors.affiliation: Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia.
authors.forename: Desalegn
authors.initials: D
authors.lastname: Massa
authors.affiliation: Department of population and Family Health, College of Health Sciences, Jimma University, Jimma, Ethiopia.
authors.forename: Amanuel
authors.initials: A
authors.lastname: Gebremedhin
authors.affiliation: ART Clinic, Filtu Hospital, Somali, Ethiopia.
authors.forename: Hafte
authors.initials: H
authors.lastname: Kahsay
authors.affiliation: Discipline of Public Health, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia. lillian.mwanri@flinders.edu.au.
authors.forename: Lillian
authors.initials: L
authors.lastname: Mwanri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D060085:Coinfection / Q000382:microbiology / Q000401:mortality* / Q000821:virology; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014376:Tuberculosis / Q000382:microbiology / Q000401:mortality*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Co-infection; Ethiopia; HIV; Mortality; Retrospective cohort; Survival; Tuberculosis