title: Five years retrospective cohort analysis of treatment outcomes of TB-HIV patients at a PEPFAR/DOTS Centre in South Eastern Nigeria.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV) associated tuberculosis (TB) remains a major global public health challenge, with an estimated 1.4 million patients worldwide. Co-infection with HIV leads to challenges in the diagnosis and treatment of patients.
  
  
  OBJECTIVE
  The aim of this study was to assess treatment outcomes of a cohort of smear positive TB-HIV co-infected patients over a five-year study period.
  
  
  METHODS
  A retrospective cohort study of 600 smear-positive tuberculosis patients registered at the chest unit of the University of Nigeria Teaching Hospital, Enugu from January 2008 to December 2012 was done. The data was analyzed using SPSS Version 17.
  
  
  RESULTS
  One hundred and three (17.2%) of the patients were co-infected with TB/HIV, while 398 (66.3%) and 99 (16.5%) were HIV negative and unknown respectively. Among the co-infected patients, 45(43.7%) were cured as against 222(55.8%) in the TB-HIV negatives (Z=4.53, p=0.000, 95%CI= 0.12-0.34). Respectively in the TB-HIV co-infected and TB-HIV negative patients, treatment completed were 21(20.4%) and 71(17.8%) (Z=9.15, p=0.000, 95%= 0.4035-0.60); defaulted 19(18.5%) vs 70 (17.6%) (Z=9.29, p=0.000, 95%CI=0.42-0.60), died 10(9.7%) vs. 6(1.5%) (Z=1.22, p=0.224, 95%CI= -0.0286-0.1086), and failures were 1(0.9%) vs. 7(1.8%) (Z=2.48, p=0.013, 95%CI=0.04-0.10). Treatment success rate was lower in TB-HIV co-infected patients, 64.1% compared to TB-HIV negative patients with 73.6%. Also those that defaulted among the TB-HIV co-infected patients (18.5%) were higher than 17.6% among TB-HIV negative patients, a difference of 0.9%.
  
  
  CONCLUSIONS
  Findings demonstrate that HIV co-infection affects TB treatment outcomes adversely. Treatment adherence, timely and sustained access to antiretroviral therapy for TB/HIV co-infected patients are important.
authors.affiliation: Department of Community Medicine, College of Medicine, University of Nigeria, Enugu Campus/University of Nigeria Teaching Hospital, Enugu.
authors.forename: Omotowo I
authors.initials: OI
authors.lastname: Babatunde
authors.affiliation: Department of Community Medicine, College of Medicine, University of Nigeria, Enugu Campus/University of Nigeria Teaching Hospital, Enugu.
authors.forename: Ekwueme O
authors.initials: EO
authors.lastname: Christiandolus
authors.affiliation: Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria.
authors.forename: Eke C
authors.initials: EC
authors.lastname: Bismarck
authors.affiliation: Department of Community Medicine, College of Medicine, University of Nigeria, Enugu Campus/University of Nigeria Teaching Hospital, Enugu.
authors.forename: Obi I
authors.initials: OI
authors.lastname: Emmanuel
authors.affiliation: Department of Community Medicine, College of Medicine, University of Nigeria, Enugu Campus/University of Nigeria Teaching Hospital, Enugu.
authors.forename: Agunwa C
authors.initials: AC
authors.lastname: Chike
authors.affiliation: Department of Community Medicine, College of Medicine, University of Nigeria, Enugu Campus/University of Nigeria Teaching Hospital, Enugu.
authors.forename: Eyisi I
authors.initials: EI
authors.lastname: Gabriel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D060085:Coinfection; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: PEPFAR/DOTS centre; Retrospective cohort analysis; South Eastern Nigeria