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Background <p>Tuberculosis (TB) is the leading cause of death among people living with HIV (PLHIV). Antiretroviral therapy (ART) initiation lowers the risk of HIV-associated TB. Earlier studies have shown TB incidence to be high in the first year of ART. We undertook a study to (1) assess the incidence of TB and (2) associated factors among persons initiating ART in a rural cohort.</p> Methods <p>We conducted a retrospective cohort analysis study among PLHIV aged ≥ 18 years, initiated on ART from January 1, 2012, to December 31, 2019, and TB disease-free at the time of ART initiation, at Kalisizo ART clinic. TB disease incidence was calculated by dividing the number of new TB cases by the total follow-up time expressed per 100 person-years among persons followed up until the date of incident TB disease, loss to follow-up, transfer out, death or censored at the end of the study; whichever occurred first. Factors associated with TB disease incidence were assessed in the multivariable analysis by Poisson regression analysis at 5% significance level.</p> Results <p>For the period 2012 to 2019, 2,589 PLHIV were initiated on ART; 57% (1,470/2,589) were female. Females were more likely to be aged below 35 years while males were more likely to be aged 25–44 years (<i>p</i> &lt; 0.001). Eighty-seven per cent (1,269/1,470) of females compared to 78% (866/1,119) of males were in WHO clinical stage 1 (<i>p</i> &lt; 0.001). Sixty-one TB disease events were observed in 7,363 person-years. The overall TB disease incidence was 0.83 (95% CI: 0.63–1.06) per 100 person-years. Males were more likely than females to develop TB disease, adjusted incidence rate ratio (adj IRR) 2.13 (95% CI: 1.27–3.57) per 100 person-years, <i>p</i> = 0.004. Compared to using ART for 0–5 months, time on ART was associated with a lower TB incidence rate at 6–12 months, 13–24 months, &gt; 24 months (adj IRR 0.20 (95% CI: 0.09–0.46), 0.14 (95% CI: 0.06–0.33), 0.16 (95% CI: 0.08–0.31) <i>p</i> &lt; 0.001 respectively).</p> Conclusions and recommendations <p>Incidence of TB among PLHIV on ART was low in this rural population. Clinicians offering care to people with HIV in the rural setting should have a heightened index of suspicion for TB disease.</p>

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Incidence and risk factors for tuberculosis at a rural HIV clinic in Uganda, 2012–2019; A retrospective cohort study

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  • 发表日期：

    2025年5月22日

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  • Ibrahim Sendagire,
  • Victor Ssempijja,
  • Anthony Ndyanabo,
  • Absalom Ssettuba,
  • Annie N. Mawanda,
  • Gertrude Nakigozi,
  • Deus Lukoye,
  • Arthur G. Fitzmaurice,
  • Richard Muhindo,
  • Stella Zawedde-Muyanja,
  • Steven J Reynolds

摘要

Background

Tuberculosis (TB) is the leading cause of death among people living with HIV (PLHIV). Antiretroviral therapy (ART) initiation lowers the risk of HIV-associated TB. Earlier studies have shown TB incidence to be high in the first year of ART. We undertook a study to (1) assess the incidence of TB and (2) associated factors among persons initiating ART in a rural cohort.

Methods

We conducted a retrospective cohort analysis study among PLHIV aged ≥ 18 years, initiated on ART from January 1, 2012, to December 31, 2019, and TB disease-free at the time of ART initiation, at Kalisizo ART clinic. TB disease incidence was calculated by dividing the number of new TB cases by the total follow-up time expressed per 100 person-years among persons followed up until the date of incident TB disease, loss to follow-up, transfer out, death or censored at the end of the study; whichever occurred first. Factors associated with TB disease incidence were assessed in the multivariable analysis by Poisson regression analysis at 5% significance level.

Results

For the period 2012 to 2019, 2,589 PLHIV were initiated on ART; 57% (1,470/2,589) were female. Females were more likely to be aged below 35 years while males were more likely to be aged 25–44 years (p < 0.001). Eighty-seven per cent (1,269/1,470) of females compared to 78% (866/1,119) of males were in WHO clinical stage 1 (p < 0.001). Sixty-one TB disease events were observed in 7,363 person-years. The overall TB disease incidence was 0.83 (95% CI: 0.63–1.06) per 100 person-years. Males were more likely than females to develop TB disease, adjusted incidence rate ratio (adj IRR) 2.13 (95% CI: 1.27–3.57) per 100 person-years, p = 0.004. Compared to using ART for 0–5 months, time on ART was associated with a lower TB incidence rate at 6–12 months, 13–24 months, > 24 months (adj IRR 0.20 (95% CI: 0.09–0.46), 0.14 (95% CI: 0.06–0.33), 0.16 (95% CI: 0.08–0.31) p < 0.001 respectively).

Conclusions and recommendations

Incidence of TB among PLHIV on ART was low in this rural population. Clinicians offering care to people with HIV in the rural setting should have a heightened index of suspicion for TB disease.