Human immunodeficiency virus as a determinant of tuberculosis treatment outcome in tuberculosis patients treated at Arba Minch General Hospital: a five-year retrospective study

Introduction
Tuberculosis/human immunodeficiency virus (TB/HIV) co-infection has a mutual and synergistic effect which mostly affects interventions that have been taken on the area. TB/HIV co-infected patients have a worse treatment outcome as compared to HIV-negative patients. There are limited data regarding the impact of HIV on the TB treatment success rate. The aim of this study was to determine the effect of HIV on TB treatment under the implementation of the directly observed treatment strategy.

Material and methods
Five-year retrospective data (from August 2012 to July 2016) of tuberculosis patients (n = 544) registered at the directly observed therapy short-course (DOTS) clinic of Arba Minch General Hospital were reviewed. The association of TB treatment outcome with HIV seropositivity was assessed according to the national tuberculosis control program guideline. Data were entered and analyzed using SPSS version 16. Odds ratios with 95% confidence intervals were used to evaluate the presence and strength of association between TB treatment outcome and HIV status.

Results
Out of the 544 TB patients, 29.2% (159) were HIV co-infected. Overall, the treatment success rate of TB patients with or without HIV was 74.6%. Using cure/completion as a reference, patients with HIV seropositivity had significantly higher odds of default (COR = 1.37; 95% CI: 0.669-2.825), failure (COR = 20.79; 95% CI: 1.065-406.019), death (COR = 6.95; 95% CI: 1.765-27.394) and transfer-out (COR = 2.59; 95% CI: 1.557-4.334).

Conclusions
The rate of treatment success in this study is still lower than the recommended 85% target set by the WHO and Ministry of Health of Ethiopia (97%). In order to further improve the treatment success rate, continuous follow-up with frequent support of patients during the treatment course and strengthening the recording system are strongly recommended.