Background: Tuberculosis (TB) is one of the most common opportunistic diseases and leading cause of death among Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) patients. There has been a drastic rise of TB infection associated with the pandemic occurrence of HIV/AIDS infection in South Africa and other resource-limited countries world-wide. South Africa faces an immense burden on health care systems posed by diagnostic and therapeutic challenges resulting from the concomitant HIV and TB epidemics. This study aimed to determine the prevalence and the factors associated with TB and HIV co-infection for patients attending clinical care at rural public health facilities in Albert Luthuli municipality of South Africa.
Methods: A cohort of HIV/AIDS patients was retrospectively followed from inception in 2010 to 2017 until TB was diagnosed or until the end of the study. Accelerated Failure Time (AFT) model was used to analyse survival data on HIV/AIDS patients. Factors associated to TB were modelled using log-logistic AFT model and further analysis of the significant factors was done using Kaplan-Meier, log-rank and hazard ratios.
Results: From 357 HIV/AIDS patients, 65 patients (18.2%) had TB. Out of the 65 HIV/AIDS patients with TB, 15 (23.1%) of them died. Thus, of the 41 HIV/AIDS patients who died during the follow-up period, 15 of them (36.6%) had TB. Log-logistic AFT model determined factors associated with TB at significance level of 0.05 as: hospital, WHO stage, treatment (regimen 1), ART adherence, follow-up CD4 count, baseline haemoglobin, follow-up white blood cell count, baseline viral load, baseline sodium and follow-up alanine transaminase.
Discussion: Although antiretroviral therapy is effective in reducing the risk of developing TB, the overall burden of TB in HIV/AIDS community may not substantially diminish.
Conclusion: TB/HIV co-infection is one of the serious public health problems in Albert Luthuli municipality. Collaborative TB/HIV activities in form of early diagnosis of both TB and HIV need a holistic approach in order to reduce drug resistance, drug toxicity, co-morbidities and mortalities which are associated with TB/HIV co-infection.