Active Search for Cases of HIV-TB co-Infection and Factors Associated with Adherence to Treatment in Co-Infected Patients in the City of Douala
Abstract
Introduction: Human Immunodeficiency Virus (HIV)-tuberculosis (TB) co-infection is among the major determinants of infectious morbidity and mortality in the developing world. Limited access to effective, quality-assured health services for these transmissible diseases among the poor is a major obstacle to achieving the Sustainable Development Goals for health. Late detection of TB/HIV co-infection is the leading cause of death among co-infected patients. Of an estimated 10.4 million new cases, only 6.1 million were detected and reported in 2015. The objective of this study was to analyze the factors associated with adherence to treatment of HIV-TB co-infected patients identified through an active search process in the city of Douala.
Materials and Methods: From April 2019 to January 2020, we conducted a two-stage observational study. In the first phase, we sought out HIV-TB co-infected patients and in the second phase, we followed up on these cases in formal and informal health facilities in the city of Douala. 42 patients participated in the study, the majority (83%) of whom were from formal health facilities. Clinical diagnoses were made based on the case definition and after that, biological tests were done for the confirmation of Microscopy Positive Pulmonary Tuberculosis (MPTP) in patients to be included in the treatment. Screened cases were submitted to a questionnaire and then followed up during the treatment period. The data collected were analyzed using SPSS version 22.0 and Microsoft Excel 2016.
Results: During the collection period we had 07 cases of TB/HIV co-infection in the informal health facilities that were referred to TB Control Centers. We had 35 cases in the formal health facilities. Of the 07 HIV-TB co-infected patients in the informal health facilities, 71.4% were between the age group 31 to 40 years. Factors linked to patients (social, psychological, and knowledge of infection factors, perception of the disease and treatment) and factors linked to treatment (simplicity of treatment and interruption in treatment) did not influence adherence to treatment. The association between these factors is not statistically significant at the 5% significance level. With a p-value of 0.001 regarding factors linked to the therapeutic environment, only the reason for consulting the health facility influences adherence to treatment by the patients surveyed. Thus, the association between the reasons for consultation in the health facility and adherence to treatment is statistically significant at the 5% significance level.
Conclusion: The main results show that most patients from both formal and informal health facilities adhered to the different treatments. There was no difference in treatment adherence between the two groups.
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