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Prevalence of HIV/AIDS and TB Co-Infection among Patients in Benin City, Nigeria

Author(s): Alex Okoh1, Vivian Omuemu2
Affiliation(s): 1General Out-Patients Department, Central Hospital, Benin City, Nigeria 2Community Health Department, University of Benin Teaching Hospital, Benin City, Nigeria
1st country of focus: Nigeria
Relevant to the conference theme: Communicable chronic diseases
Summary (max 100 words): HIV/AIDS and Tuberculosis (TB) co-infection means the existence of these two disease entities together in a particular patient at the same time. The prevalence of this type of condition (co-infection) among the population covered by the PEPFAR/Dermatology Clinic of the Central Hospital, Benin City is the focus of this study. TB represents the most serious opportunistic infection in HIV infected patients and a leading cause of death in HIV infected patients. The global impact of the converging dual epidemics of TB and HIV is one of the major public health challenges of our time.
Background (max 200 words): It is estimated that one-third of the 40 million people living with HIV/AIDS worldwide are co-infected with TB. People with HIV are up to 50 times more likely to develop TB in a given year than HIV-negative people. The HIV epidemic has completely destabilized TB control in high HIV prevalence regions. Today 50% or more of new TB cases are also HIV co-infected in Southern and Eastern Africa, which is the centre of HIV/TB epidemic. Nigeria has an estimated incidence of nearly 300,000 cases of all TB forms annually, ranking it as the 5th highest TB-burden country in the world. Recorded HIV prevalence among TB patients rose from 2.2% to 17% from1991 to 2000. The Directly Observed Treatment Short course (DOTS) strategy adopted by TB control programs in the majority of countries has not been sufficient to control HIV associated TB, particularly in sub-Sahara Africa, as a result of the unprecedented increases in TB case load. Although the global incidence of TB has taken a downward trend in recent years, incidence has increased in Sub-Saharan Africa in areas of high HIV prevalence. As a result, there are currently more new TB cases each year than ever before.
Objectives (max 100 words): This study set out to determine the proportion of patients with HIV/AIDS and TB co-infection among the patients attending PEPFAR/Dermatology Clinic, Central Hospital, Benin City and to identify the factors associated with HIV/AIDS-TB co-infection.  If the prevalence of the co-infection in this study is found to be high, the linkage of the management of these two conditions, especially at community level, could be advocated for to reduce the opportunity cost for People Living with HIV/AIDS who also need TB treatment. Also, a better understanding of the epidemiological factors associated with the co-infection in our immediate environment would be provided.
Methodology (max 400 words): Central hospital, Benin City, a tertiary health institution, centrally located at the heart of the city, receives patients from the nooks and crannies of the city and even the state at large. PEPFAR/dermatology clinic is one of the specialist clinics run in the medical out-patients department of the central hospital. HIV positive cases are mainly seen in this clinic for treatment and follow up.  A descriptive cross-sectional study design was carried out. The study population comprised of patients presenting in the hospital PEPFAR clinic within the period of study.  Systematic sampling method was applied. In applying this method, the first respondent was selected by simple random sampling, after which subsequent respondents were selected at the ratio of 1:2. By this about 75 patients were selected a week, since about 150 patients were seen each week in the clinic. Thus, the minimum sample size of 350 was reached within the first five weeks of the study. Data was collected from eligible subjects at a sampling interval of 2 during the survey period, which is to say for every clinic attendance, patients were picked alternately for the study as they arrived. Every eligible patient that attended the clinic each day had a 50% chance of participating in the study. In 5 weeks about 350 respondents were already sampled, which was clearly in excess of the minimum sample size of 334 estimated.  Data collection was by the use of interviewer administered structured questionnaires. Interviewers were recruited to assist in administering the questionnaires after a period of training and standardization of instruments.  Both clinical and laboratory diagnosis was used as evidence for existence of HIV and TB infections. References were also made to individual patient’s case records to confirm claims of HIV/TB status as well as their mode of diagnosis.  The standardized questionnaires were pretested in University of Benin Teaching Hospital PEPFAR/Dermatology clinic, Benin City. After the pretesting, necessary corrections and adjustments were made on the instrument before the study in Central Hospital, Benin City. Data collected was analysed using the SPSS (Statistical Package for Social Sciences) version 13.0 software. Level of statistical significance was put at p < 0.05. Data was presented in graphic and non graphical forms as appropriate. Test of associations were also applied where necessary.
Results (max 400 words): RESULTS: HIV/TB co-infection rate of 19.8% was found from the study. Of this, 8.7% were unable to access TB treatment, while 70% of the respondents were on treatment for HIV/AIDS (HAART). 60% had no opportunistic infection and 85% had no other STIs. Over 70% of the respondents do not use psychoactive drugs.  The socio-demographic characteristics of those co-infected clearly showed that respondents in the age group of 31-40 years had the highest frequency (22.5%) followed by the 21-30 years age group (20.5%). The least occurrence was seen in the less than 10 years age group. HIV/AIDS, we know, is mostly transmitted by the sexual route, hence, the sexually active age group (15-45 years), had the highest co-infection rate of HIV/TB. Across the various levels of education, the highest co-infection rate of 26.9% was seen among respondents with no formal education, followed by those with primary education (20.5%). Majority (68.4%) of the respondents were already on treatment for HIV/AIDS (HAART), this has been found to improve the outcome of HIV infected patients with TB in a study done in Abuja, Nigeria in 2005. This probably explains why only 19.8% of our respondents had TB. This could also explain the finding in which over 60% of the respondents had no opportunistic infection.
Conclusion (max 400 words): CONCLUSION: In this study, the HIV/TB co-infection rate was found to be about 20% bearing in mind that it is purely a clinical cross sectional study with its attendant limitations (e.g. the unavoidable Becksonian bias in hospital based studies). As a follow up to the outcome of this study, the linkage of the management of these two conditions, especially at community level is recommended since our result suggested a steady increase in co-infection rates over the recent years. Among the 20% of respondents that were co-infected about 9% of them could not access TB treatment (DOTS) in the hospital for mere bureaucratic reasons coupled with ignorance on the part of the patients. Characteristically, the sexually active age group was more among this 20%. Also prompt commencement and regular administration of highly active antiretroviral treatment (HAART), DOTS and BCG immunization earlier in life, tended to influence the co-infection rate.  It is suggested that centres offering DOTS treatment should further simplify its implementation process to promote access. Patients should be properly educated on the need and process of the HAART and DOTS strategy.  Also programmes and campaigns aimed at reducing the HIV/TB co-infection rate should be targeted mostly at the reproductive/sexually active groups in the society as well as the illiterate and semi-literate groups.

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