Tuberculosis treatment default among TB-HIV co-infected patients in Nigeria

How to cite this article:
Ukwaja KN. Tuberculosis treatment default among TB-HIV co-infected patients in Nigeria. Ann Trop Med Public Health 2013;6:382-3
How to cite this URL:
Ukwaja KN. Tuberculosis treatment default among TB-HIV co-infected patients in Nigeria. Ann Trop Med Public Health [serial online] 2013 [cited 2020 Sep 24];6:382-3. Available from: https://www.atmph.org/text.asp?2013/6/3/382/121018

Dear Sir,

Few studies have specifically evaluated risk factors for TB treatment default among TB/HIV-infected patients. [1],[2],[3] Nigeria is a high TB/HIV burden country. The current national default rate among smear-positive TB patients is 8%, [4] but for unclear reasons, a recent study found a default rate of 30% among TB/HIV patients treated for TB. [5] This study determined the trends, timing, and factors associated with TB treatment default among HIV-infected patients.

A retrospective cohort study design was used to evaluate defaulters among TB/HIV infected patients treated for tuberculosis during January 2006-December 2010. TB diagnosis and HIV were performed according to standard methods. Using the institutional TB registers, information on patients’ registration status, age, gender, residence, smear/disease status, and treatment outcome were collected. The data were then sorted out into the six treatments outcomes-cured, treatment completed, defaulted, died, treatment failure, and transferred out. The defaulters were then compared to non-defaulters. Data analyses were performed using Epi Info (CDC Atlanta, version 3.4.1).

Of the 189 HIV-infected TB patients, 57 (30%) defaulted from TB treatment. The proportion of patients who defaulted showed an increasing trend over the study period [2 (8%) in 2006, 18 (38%) in 2007, 8 (24%) in 2008, 6 (20%) in 2009, and 23 (43%) in 2010], (trend χ2 =12.7; P = 0.013). The mean age of the defaulters was 36 (±11) years, while for non-defaulters; it was 30 (±14) years (Mann-Whitney test=6.36, P = 0.012). Overall, 56 (98%) of the defaulters were older than 15 years; 31 (54%) were males [Table 1]. Also, 46 (81%) of the study patients defaulted during/just after the intensive phase of treatment. Overall, mean default time was 2.2 (±0.3) months. In univariate analysis, factors significantly associated with treatment default were; older age (≥15 years) (P = 0.003), and rural residence (P < 0.001) [Table 1].

Table 1: Patients’ characteristics and factors influencing treatment default among HIV-infected tuberculosis patients in a tertiary hospital in Nigeria (n = 189)

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This study showed an increasing trend of default rate among TB/HIV patients in Nigeria. Our average default rate was lower than 11-21.7% reported in Uganda and Brazil. [1],[2] Also, most patients defaulted during or at the end of intensive phase of treatment; this was far lower than the mean default time of five months found in Uganda. [2] The reasons for this difference is not clear, it probably reflect differences in the qualities of care given. Also, in this study, subjects 15 years or older were more likely to default than younger patients. This is in contrast to what was found in Brazil where older subjects (>29 years) were less likely to default. [1] The reasons for this difference are not clear, but overall defaulters were older in our study. Also, rural residence was associated with treatment default. This may be due to longer distance of travelling to the hospital located in an urban area. [1] Reducing default among HIV-infected TB patients in Nigeria will likely require further intensification of patients’ education during the intensive phase of treatment and further decentralization of TB/HIV collaborative activities in rural communities.

References
1. Maruza M, Albuquerque MF, Coimbra I, Moura LV, Montarroyos UR, Miranda Filho DB, et al. Risk factors for default from tuberculosis treatment in HIV-infected individuals in the state of Pernambuco, Brazil: A prospective cohort study. BMC Infect Dis 2011;11:351.
2. Elbireer S, Guwatudde D, Mudiope P, Nabbuye-Sekandi J, Manabe YC. Tuberculosis treatment default among HIV-TB co-infected patients in urban Uganda. Trop Med Int Health 2011;16:981-7.
3. Kittikraisak W, Burapat C, Kaewsa-ard S, Watthanaamornkiet W, Sirinak C, Sattayawuthipong W, et al. Factors associated with tuberculosis treatment default among HIV-infected tuberculosis patients in Thailand. Trans R Soc Trop Med Hyg 2009;103:59-66.
4. WHO. Global Tuberculosis Control: WHO report 2011. Geneva, Switzerland: World Health Organisation; 2011. (WHO/HTM/TB/2011.16).
5. Ifebunandu NA, Ukwaja KN, Obi SN. Treatment outcome of HIV-associated tuberculosis in a resource-poor setting. Trop Doct 2012;42:74-6.

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/1755-6783.121018

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