Incidence rate of tuberculosis and predictors of unfavorable treatment outcomes among adolescents and young adults initiating antiretroviral therapy in Dar es salaam, 2020 - 2023: a retrospective cohort study

Abstract

ABSTRACT Background: Adolescents and young adults (AYA) with HIV infection in sub-Saharan Africa are at high risk of dying from tuberculosis (TB) due to extreme poverty, violence and stigma, and defaulting TB treatment. Despite these risks, estimates of poor TB treatment outcomes among this population are limited in Tanzania as majority of the TB reports divide the population in two group adults (over 15 years old) and children (ages 0 14) ignoring 15-24 years as a distinct group. This study aimed to evaluate the incidence of TB and predictors for poor TB treatment outcomes among 10-24 years old adolescents and young adults (AYA) starting antiretroviral therapy (ART) in Dar es Salaam. Study objective: To determine the incidence rate of TB and predictors for poor TB treatment outcomes among AYA living with HIV in Dar es Salaam. Method: A retrospective cohort study, conducted in Dar es Salaam using data collected from Care and Treatment Centre (CTC) 2 database between January 2020 to December 2023. Patients with HIV aged 10 to 24 years who were on ART between January 2020 and December 2023 were included The incidence of TB was calculated by dividing newly . diagnosed cases by person-years of follow-up. TB prevalence was calculated by the number of HIV-infected AYA tested positive for TB over the total number of HIV-infected AYA during the study period. A multivariable Cox proportional hazards regression model was used to identify risk factors for poor TB treatment outcomes. Result: Among 19,021 HIV-infected AYA, 34 (0.2%) had TB, with a high prevalence in the 20-24 year age group (67.6%). The TB incidence rate was 8.6 per 1000 person year (95% CI; 5.2-14.1/cases per 1000 person year at risk), with the highest rates observed in males 20.5 per 1000 person year (95% CI; 9.2-45.7/1000 person years at risk), young adults 9.1per 1000 person year (95% CI; 5.1-16.1/1000 person years at risk), and WHO clinical stage 4 had 46.3 per 1000 person year (95% CI; 14.9-143.6/1000 person years at risk). The outcome of death was high 11/31 (35.5%). We did not identify significant predictors for poor treatment outcomes in this study. Conclusion: We observed a low prevalence of TB, low incidence of TB, and the most affected age group was 20-24 years in terms of burden, incidence and mortality. To achieve the goal of reducing poor treatment outcomes, it is recommended to sustain the existing xii strategies such as the TPT provision and ART adherence, to improve early TB case detection, to strengthen follow-up of 20-24 years after initiation of treatment, further investigation is needed using a large National dataset to get a more comprehensive findings