Time to Develop&nbsp;Pulmonary Tuberculosis&nbsp;and Predictors&nbsp;Among HIV Infected Children Receiving Anti-Retroviral Therapy&nbsp;in&nbsp;Assosa and&nbsp;Pawe General Hospitals, North West Ethiopia 2020

doi:10.21203/rs.3.rs-89428/v1

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Time to Develop Pulmonary Tuberculosis and Predictors Among HIV Infected Children Receiving Anti-Retroviral Therapy in Assosa and Pawe General Hospitals, North West Ethiopia 2020

https://doi.org/10.21203/rs.3.rs-89428/v1

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Recently, pulmonary tuberculosis (PTB) incidence is a serious co-infection and an emerging global concern for children living with human immune deficiency virus (HIV). However, the incidence of PTB among adult HIV patients is exhaustively studied; the incidence of PTB among children on ART is overlooked. This research provides invaluable time based relevant actionsclues.

Objective:- Hospital-based retrospective cohort study was conducted among 359 HIV infected children those registered on ART since 2009-2018. Time to develop PTB defined as the time from enrollment for ART care until the development of PTB. The proportional hazard assumption was checked for each variable and no variable was found with Schoenfeld test <0.05. Variables with P-value <0.25 at bivariate Cox regression analysis were entered into the multivariable Cox model. Multivariable Cox regression model with 95%CI and AHR used to identify significant predictor.

Result:-Totally 359 HIV infected children followed and produced 686.5 Person per Years of observation (PYOs) with minimum and maximum follow up time on ART was 0.34 & 5.1 years, respectively. The median age of the children was 9 (SD±3.78) years. The overall incidence density of PTB was 7.2 Person/100years in 95%CI (5.52--- 9.24).Notably being age group >= 11 years (AHR=5.1 95% CI 1.4--18.), who stage 3&4 (AHR= 3.4 times increase the risks of PTB developed was compared WHO clinical stage 1& 2 (AHR=3.4 95%CI: 1.2-9.7). Being sever underweight (AHR=3.2 95%CI: 1.3--7.8), not started INHAHR =2.8, 95%CI: 1.1 -7.2) and having previous opportunistic infections (AHR= 2.34 95%CI: 1.3--4.1) significantly associated with PTB incidence.

Conclusion:-The incidence of PTB in HIV infected children were found higher as compared with evidence from previous findings. Strengthening intensified screening of INH and therapeutic feeding needs for risk children highly recommended.

Pulmonology

Infectious Diseases

incidence and predictors

HIV infected children

Pulmonary TB

Ethiopia

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Table 1

Baseline socio-demographic characteristics of children living with HIV receiving ART in Assosa and Pawe General Hospitals for incidence and predictors of PTB 2019
Variables		Characteristics	Frequency			Percent
sex		Male Female	169 190			47.08 52.92
Age		<= 5 years 6 -10 years >= 11 years	93 137 129			25.91 38.16 35.93
Residence		Urban Rural	183 176			50.97 49.03
Religion		orthodox Muslim protestant catholic others	156 74 90 31 8			43.45 20.61 25.07 8.64 2.23
Family size		<=2 3-4 5-6	106 191 62			29.53 53.20 17.27
Parental status		Both parent alive Paternal orphan Maternal orphan Both parent orphan	210 100 30 19			58.50 27.86 8.36 5.57
Mode of HIV diagnosed	Rapid PCR			279 80	77.72 22.28
Functional status	Working Ambulatory Bedridden			248 70 41	69.08 19.50 11.42
CPT	Yes Not			281 78	78.27 21.73
IPT	Yes No			214	59.61
				145	40.39
Hemoglobin	<10 gram/dl >=10 gram/dl			126 233	35.10 64.90
CD4 Count	< 100 101-200 >=200			14 52 293	3.90 14.48 81.62
Who staging	Stage 1 Stage 2 Stage 3 Stage 4			102 129 81 47	28.42 35.93 22.56 13.09
Vaccination status	Vaccinated Vaccination not updated Not recorded			195 62 102	54.32 17.27 28.41
Children status (during data collection time)	Being on follow up Lost from follow up Transfer in to adult cohort Transfer out Died Drop			170 25 81 55 8 20	47.35 6.96 22.56 15.32 2.23 5.57
Opportunistic infection	Yes No			103 256	28.69 71.31
ART Adherence	Good Fair Poor			192 104 63	53.48 28.97 17.55

Table 2

Cumulative PBT free survival rate in HIV infected children at Assosa and Pawe general hospitals since 2009-2018.
Years	Survival rate	95%CI	new incidence	Cumulative
1years	96.4%	0.93 ---0.98	12	12	20.3
2 years	83.83%	0.78---0.88	30	42	71.1
3 years	77.56%	0.62--- 0.84	6	48	82.1
4 years	57.92%	0.49-- 0.75	6	54	91.6
≥5 years	39%	0.37 ---55.5	5	59	100

Table 3

Bivariable and Multivariable cox proportional hazard regression model in HIV positive children at Assosa and Pawe General Hospitals, 2019.

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Time to Develop Pulmonary Tuberculosis and Predictors Among HIV Infected Children Receiving Anti-Retroviral Therapy in Assosa and Pawe General Hospitals, North West Ethiopia 2020

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