Mortality rate and associated factors among patients co-infected with drug resistant tuberculosis and HIV at Mulago Hospital

Abstract

Drug resistant tuberculosis (DR-TB)/HIV co-infection remains a growing threat to public health and threatens global TB and HIV control programs. HIV is likely to worsen the outcomes of DR-TB and DR-TB is likely to worsen the outcomes of HIV despite the scale up of TB and HIV services and advances in treatment and diagnosis. To determine the mortality rate and factors associated with mortality among patients with drug resistant TB/HIV co-infection at Mulago Hospital. This study employed a retrospective cohort study design. It was carried out in Mulago Hospital tuberculosis unit and the eligible participants were those with DR-TB and HIV co-infec-tion. Pre-tested structured data extraction forms were used to obtain information from the patients’ medical records by trained research assistants. Data on sociodemographics, HIV and TB clinical characteristics was collected. Data were analyzed in STATA version 14.0. At univariate, data were presented in form of medians with corresponding interquartile ranges for continuous data while frequencies and percentages were used for categorical variables. Modified poisson regression with robust standard errors was used to determine relationships between the independent variables and the dependent variable (mortality) at bivariate and multivariate analysis. Of the 390 participants enrolled, 201(53.9%) were males with a mean age of 34.7 (±10.6) and 128 (32.8%, 95% CI=28.3-37.7%) died. ART initiation (aIRR 0.79, 95% CI= 0.71-0.88), hav-ing a BMI ≥18.5Kg/m2 (aIRR 0.91, 95% CI= 0.85-0.97), having a documented patient phone con-tact (aIRR 0.85, 95% CI=0.76-0.97), having a MUAC ≥24.5cm (aIRR 0.83, 95% CI= 0.78-0.88) and having an adverse event during the course of treatment (aIRR 0.81, 95% CI= 0.75-0.87) were protective against mortality. There was a significantly high mortality rate due to the DR-TB/HIV co-infection. Having a side effect, BMI ≥18.5Kg/m2, starting ART and MUAC ≥24.5cm were protective against mortality. These results suggest that initiation of all HIV positive patients with DR-TB on ART and frequent monitoring of drug side effects highly reduce mortality.