Tuberculosis (TB) remains a leading cause of morbidity and mortality among people living with HIV. TB/HIV co-infection continues to challenge global TB control efforts. This study aimed to estimate the incidence and identify predictors of TB among adult HIV-infected patients who initiated antiretroviral therapy (ART) under the Universal Test and Treat (UTT) approach in Silte Zone, Ethiopia. An institution-based retrospective cohort study was conducted among 404 adult HIV patients enrolled in ART. Participants were selected using simple random sampling. Data were extracted using a structured checklist via Kobo Toolbox and analyzed using STATA version 14. Cox proportional hazards regression models were applied to identify predictors of TB. Statistical significance was declared at p < 0.05 with 95% confidence intervals. The proportional hazards assumption was assessed using statistical tests and graphical methods. The median age was 36 years, with near-equal sex distribution. Most participants initiated ART at WHO clinical stages I–II. Approximately 70% had good adherence, and over 80% disclosed their HIV status. The predominant regimen was TDF-3TC-EFV. The overall TB incidence density rate was 5.33 per 1000 person-months (95% CI: 3.68–7.77). The incidence of new TB was 4.0 per 1000 person-months (95% CI: 2.60–6.13), while reinfection was 1.3 per 1000 person-months (95% CI: 0.63–2.70). TB-free survival probabilities at 6, 12, and 18 months were 0.99, 0.93, and 0.90, respectively. Male sex (AHR: 5.05), non-disclosure of HIV status (AHR: 6.29), underweight status (AHR: 3.07), CD4 count <200 cells/μL (AHR: 5.63), and poor ART adherence (AHR: 7.05) were significant predictors. Although TB incidence declined under the UTT approach, risk remained elevated during the first year of ART. Targeted interventions promoting early diagnosis, adherence support, nutritional care, and safe disclosure are essential to reduce TB burden among people living with HIV.
Sherfa et al. (Fri,) studied this question.