Burden of mortality and its predictors among TB-HIV co-infected patients in Ethiopia: Systematic review and meta-analysis
Human immunodeficiency virus (HIV) and tuberculosis (TB) are still the two major deadly pandemics globally, causes 167,000 deaths in 2022. The two lethal combinations pose a substantial challenge to public health, especially in areas with high burden of both diseases such as Sub-Saharan Africa inclu...
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| Published in | PloS one Vol. 19; no. 11; p. e0312698 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
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United States
Public Library of Science
07.11.2024
Public Library of Science (PLoS) |
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| Abstract | Human immunodeficiency virus (HIV) and tuberculosis (TB) are still the two major deadly pandemics globally, causes 167,000 deaths in 2022. The two lethal combinations pose a substantial challenge to public health, especially in areas with high burden of both diseases such as Sub-Saharan Africa including Ethiopia. However, there is no study that showed national figure on mortality of TB/HIV co-infected patients. Hence, this review intended to provide pooled mortality rate and its predictors among patients co- infected with twin pandemics.
Using reputable electronic data bases, primary studies were searched from January 25 to February 5, 2024. The review included papers published in English language conducted between 2004 and 2024. Heterogeneity between included studies was evaluated using Cochrane Q-test and the I2 statistics. Sub-group analysis was done to mitigate significant heterogeneity. Sensitivity analysis was also done to evaluate the effect of single studies on pooled estimated result.
In this systematic review and meta-analysis a total of 5,210 study participants were included from 15 primary studies. The review disclosed that the pooled proportion and incidence of mortality were 18.73% (95% CI: 15.92-20.83) and 4.94 (95% CI: 2.98-6.89) respectively. Being bedridden and ambulatory functional status, poor ART adherence, CD4 count below the threshold (<200 cells/mm3), advanced WHO clinical staging, not provision of cotrimoxazole and isoniazid preventing therapy, anemia and extra pulmonary TB were significant predictors of mortality.
The analyzed data of this systematic review and meta-analysis depicted that the national pooled proportion and incidence of mortality among TB-HIV co-infected patients were considered to be still high. The authors strongly recommended scale up and continuous provision of cotrimoxazole and isoniazid preventive therapy. In addition, early identification and treatment of anemia will greatly halt the high burden of mortality. Generally, to reduce mortality and improve survival, a collaborative effort is mandatory to emphasize close follow up of patients with identified predictors. |
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| AbstractList | Human immunodeficiency virus (HIV) and tuberculosis (TB) are still the two major deadly pandemics globally, causes 167,000 deaths in 2022. The two lethal combinations pose a substantial challenge to public health, especially in areas with high burden of both diseases such as Sub-Saharan Africa including Ethiopia. However, there is no study that showed national figure on mortality of TB/HIV co-infected patients. Hence, this review intended to provide pooled mortality rate and its predictors among patients co- infected with twin pandemics.BACKGROUNDHuman immunodeficiency virus (HIV) and tuberculosis (TB) are still the two major deadly pandemics globally, causes 167,000 deaths in 2022. The two lethal combinations pose a substantial challenge to public health, especially in areas with high burden of both diseases such as Sub-Saharan Africa including Ethiopia. However, there is no study that showed national figure on mortality of TB/HIV co-infected patients. Hence, this review intended to provide pooled mortality rate and its predictors among patients co- infected with twin pandemics.Using reputable electronic data bases, primary studies were searched from January 25 to February 5, 2024. The review included papers published in English language conducted between 2004 and 2024. Heterogeneity between included studies was evaluated using Cochrane Q-test and the I2 statistics. Sub-group analysis was done to mitigate significant heterogeneity. Sensitivity analysis was also done to evaluate the effect of single studies on pooled estimated result.METHODSUsing reputable electronic data bases, primary studies were searched from January 25 to February 5, 2024. The review included papers published in English language conducted between 2004 and 2024. Heterogeneity between included studies was evaluated using Cochrane Q-test and the I2 statistics. Sub-group analysis was done to mitigate significant heterogeneity. Sensitivity analysis was also done to evaluate the effect of single studies on pooled estimated result.In this systematic review and meta-analysis a total of 5,210 study participants were included from 15 primary studies. The review disclosed that the pooled proportion and incidence of mortality were 18.73% (95% CI: 15.92-20.83) and 4.94 (95% CI: 2.98-6.89) respectively. Being bedridden and ambulatory functional status, poor ART adherence, CD4 count below the threshold (<200 cells/mm3), advanced WHO clinical staging, not provision of cotrimoxazole and isoniazid preventing therapy, anemia and extra pulmonary TB were significant predictors of mortality.RESULTSIn this systematic review and meta-analysis a total of 5,210 study participants were included from 15 primary studies. The review disclosed that the pooled proportion and incidence of mortality were 18.73% (95% CI: 15.92-20.83) and 4.94 (95% CI: 2.98-6.89) respectively. Being bedridden and ambulatory functional status, poor ART adherence, CD4 count below the threshold (<200 cells/mm3), advanced WHO clinical staging, not provision of cotrimoxazole and isoniazid preventing therapy, anemia and extra pulmonary TB were significant predictors of mortality.The analyzed data of this systematic review and meta-analysis depicted that the national pooled proportion and incidence of mortality among TB-HIV co-infected patients were considered to be still high. The authors strongly recommended scale up and continuous provision of cotrimoxazole and isoniazid preventive therapy. In addition, early identification and treatment of anemia will greatly halt the high burden of mortality. Generally, to reduce mortality and improve survival, a collaborative effort is mandatory to emphasize close follow up of patients with identified predictors.CONCLUSION AND RECOMMENDATIONSThe analyzed data of this systematic review and meta-analysis depicted that the national pooled proportion and incidence of mortality among TB-HIV co-infected patients were considered to be still high. The authors strongly recommended scale up and continuous provision of cotrimoxazole and isoniazid preventive therapy. In addition, early identification and treatment of anemia will greatly halt the high burden of mortality. Generally, to reduce mortality and improve survival, a collaborative effort is mandatory to emphasize close follow up of patients with identified predictors. Background Human immunodeficiency virus (HIV) and tuberculosis (TB) are still the two major deadly pandemics globally, causes 167,000 deaths in 2022. The two lethal combinations pose a substantial challenge to public health, especially in areas with high burden of both diseases such as Sub-Saharan Africa including Ethiopia. However, there is no study that showed national figure on mortality of TB/HIV co-infected patients. Hence, this review intended to provide pooled mortality rate and its predictors among patients co- infected with twin pandemics. Methods Using reputable electronic data bases, primary studies were searched from January 25 to February 5, 2024. The review included papers published in English language conducted between 2004 and 2024. Heterogeneity between included studies was evaluated using Cochrane Q-test and the I.sup.2 statistics. Sub-group analysis was done to mitigate significant heterogeneity. Sensitivity analysis was also done to evaluate the effect of single studies on pooled estimated result. Results In this systematic review and meta-analysis a total of 5,210 study participants were included from 15 primary studies. The review disclosed that the pooled proportion and incidence of mortality were 18.73% (95% CI: 15.92-20.83) and 4.94 (95% CI: 2.98-6.89) respectively. Being bedridden and ambulatory functional status, poor ART adherence, CD4 count below the threshold (200 cells/mm.sup.3 ), advanced WHO clinical staging, not provision of cotrimoxazole and isoniazid preventing therapy, anemia and extra pulmonary TB were significant predictors of mortality. Conclusion and recommendations The analyzed data of this systematic review and meta-analysis depicted that the national pooled proportion and incidence of mortality among TB-HIV co-infected patients were considered to be still high. The authors strongly recommended scale up and continuous provision of cotrimoxazole and isoniazid preventive therapy. In addition, early identification and treatment of anemia will greatly halt the high burden of mortality. Generally, to reduce mortality and improve survival, a collaborative effort is mandatory to emphasize close follow up of patients with identified predictors. Human immunodeficiency virus (HIV) and tuberculosis (TB) are still the two major deadly pandemics globally, causes 167,000 deaths in 2022. The two lethal combinations pose a substantial challenge to public health, especially in areas with high burden of both diseases such as Sub-Saharan Africa including Ethiopia. However, there is no study that showed national figure on mortality of TB/HIV co-infected patients. Hence, this review intended to provide pooled mortality rate and its predictors among patients co- infected with twin pandemics. Using reputable electronic data bases, primary studies were searched from January 25 to February 5, 2024. The review included papers published in English language conducted between 2004 and 2024. Heterogeneity between included studies was evaluated using Cochrane Q-test and the I.sup.2 statistics. Sub-group analysis was done to mitigate significant heterogeneity. Sensitivity analysis was also done to evaluate the effect of single studies on pooled estimated result. In this systematic review and meta-analysis a total of 5,210 study participants were included from 15 primary studies. The review disclosed that the pooled proportion and incidence of mortality were 18.73% (95% CI: 15.92-20.83) and 4.94 (95% CI: 2.98-6.89) respectively. Being bedridden and ambulatory functional status, poor ART adherence, CD4 count below the threshold (200 cells/mm.sup.3 ), advanced WHO clinical staging, not provision of cotrimoxazole and isoniazid preventing therapy, anemia and extra pulmonary TB were significant predictors of mortality. The analyzed data of this systematic review and meta-analysis depicted that the national pooled proportion and incidence of mortality among TB-HIV co-infected patients were considered to be still high. The authors strongly recommended scale up and continuous provision of cotrimoxazole and isoniazid preventive therapy. In addition, early identification and treatment of anemia will greatly halt the high burden of mortality. Generally, to reduce mortality and improve survival, a collaborative effort is mandatory to emphasize close follow up of patients with identified predictors. Background Human immunodeficiency virus (HIV) and tuberculosis (TB) are still the two major deadly pandemics globally, causes 167,000 deaths in 2022. The two lethal combinations pose a substantial challenge to public health, especially in areas with high burden of both diseases such as Sub-Saharan Africa including Ethiopia. However, there is no study that showed national figure on mortality of TB/HIV co-infected patients. Hence, this review intended to provide pooled mortality rate and its predictors among patients co- infected with twin pandemics. Methods Using reputable electronic data bases, primary studies were searched from January 25 to February 5, 2024. The review included papers published in English language conducted between 2004 and 2024. Heterogeneity between included studies was evaluated using Cochrane Q-test and the I 2 statistics. Sub-group analysis was done to mitigate significant heterogeneity. Sensitivity analysis was also done to evaluate the effect of single studies on pooled estimated result. Results In this systematic review and meta-analysis a total of 5,210 study participants were included from 15 primary studies. The review disclosed that the pooled proportion and incidence of mortality were 18.73% (95% CI: 15.92-20.83) and 4.94 (95% CI: 2.98-6.89) respectively. Being bedridden and ambulatory functional status, poor ART adherence, CD4 count below the threshold (< 200 cells/mm 3 ), advanced WHO clinical staging, not provision of cotrimoxazole and isoniazid preventing therapy, anemia and extra pulmonary TB were significant predictors of mortality. Conclusion and recommendations The analyzed data of this systematic review and meta-analysis depicted that the national pooled proportion and incidence of mortality among TB-HIV co-infected patients were considered to be still high. The authors strongly recommended scale up and continuous provision of cotrimoxazole and isoniazid preventive therapy. In addition, early identification and treatment of anemia will greatly halt the high burden of mortality. Generally, to reduce mortality and improve survival, a collaborative effort is mandatory to emphasize close follow up of patients with identified predictors. Human immunodeficiency virus (HIV) and tuberculosis (TB) are still the two major deadly pandemics globally, causes 167,000 deaths in 2022. The two lethal combinations pose a substantial challenge to public health, especially in areas with high burden of both diseases such as Sub-Saharan Africa including Ethiopia. However, there is no study that showed national figure on mortality of TB/HIV co-infected patients. Hence, this review intended to provide pooled mortality rate and its predictors among patients co- infected with twin pandemics. Using reputable electronic data bases, primary studies were searched from January 25 to February 5, 2024. The review included papers published in English language conducted between 2004 and 2024. Heterogeneity between included studies was evaluated using Cochrane Q-test and the I2 statistics. Sub-group analysis was done to mitigate significant heterogeneity. Sensitivity analysis was also done to evaluate the effect of single studies on pooled estimated result. In this systematic review and meta-analysis a total of 5,210 study participants were included from 15 primary studies. The review disclosed that the pooled proportion and incidence of mortality were 18.73% (95% CI: 15.92-20.83) and 4.94 (95% CI: 2.98-6.89) respectively. Being bedridden and ambulatory functional status, poor ART adherence, CD4 count below the threshold (<200 cells/mm3), advanced WHO clinical staging, not provision of cotrimoxazole and isoniazid preventing therapy, anemia and extra pulmonary TB were significant predictors of mortality. The analyzed data of this systematic review and meta-analysis depicted that the national pooled proportion and incidence of mortality among TB-HIV co-infected patients were considered to be still high. The authors strongly recommended scale up and continuous provision of cotrimoxazole and isoniazid preventive therapy. In addition, early identification and treatment of anemia will greatly halt the high burden of mortality. Generally, to reduce mortality and improve survival, a collaborative effort is mandatory to emphasize close follow up of patients with identified predictors. BackgroundHuman immunodeficiency virus (HIV) and tuberculosis (TB) are still the two major deadly pandemics globally, causes 167,000 deaths in 2022. The two lethal combinations pose a substantial challenge to public health, especially in areas with high burden of both diseases such as Sub-Saharan Africa including Ethiopia. However, there is no study that showed national figure on mortality of TB/HIV co-infected patients. Hence, this review intended to provide pooled mortality rate and its predictors among patients co- infected with twin pandemics.MethodsUsing reputable electronic data bases, primary studies were searched from January 25 to February 5, 2024. The review included papers published in English language conducted between 2004 and 2024. Heterogeneity between included studies was evaluated using Cochrane Q-test and the I2 statistics. Sub-group analysis was done to mitigate significant heterogeneity. Sensitivity analysis was also done to evaluate the effect of single studies on pooled estimated result.ResultsIn this systematic review and meta-analysis a total of 5,210 study participants were included from 15 primary studies. The review disclosed that the pooled proportion and incidence of mortality were 18.73% (95% CI: 15.92-20.83) and 4.94 (95% CI: 2.98-6.89) respectively. Being bedridden and ambulatory functional status, poor ART adherence, CD4 count below the threshold (<200 cells/mm3), advanced WHO clinical staging, not provision of cotrimoxazole and isoniazid preventing therapy, anemia and extra pulmonary TB were significant predictors of mortality.Conclusion and recommendationsThe analyzed data of this systematic review and meta-analysis depicted that the national pooled proportion and incidence of mortality among TB-HIV co-infected patients were considered to be still high. The authors strongly recommended scale up and continuous provision of cotrimoxazole and isoniazid preventive therapy. In addition, early identification and treatment of anemia will greatly halt the high burden of mortality. Generally, to reduce mortality and improve survival, a collaborative effort is mandatory to emphasize close follow up of patients with identified predictors. |
| Audience | Academic |
| Author | Zeleke, Shegaw Kassaw, Amare Aytenew, Tigabu Munye Dessalegn, Nigatu Kefale, Demewoz Asferie, Worku Necho Agimas, Muluken Chanie Azmeraw, Molla Sinshaw, Mastewal Ayehu |
| AuthorAffiliation | 1 Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia 3 Department of Pediatrics and Child Health Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia 7 Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia 2 Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia Hawassa University College of Medicine and Health Sciences, ETHIOPIA 6 Department of Pediatrics and Child Health Nursing, College of Health Sciences, Injibara University, Injibara, Ethiopia 4 Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia 5 Department of Nursing, Tibebe Gion Specialized Hospital, Bahir Bar University, Bahir Bar University, Bahir Dar, Ethiopia |
| AuthorAffiliation_xml | – name: 2 Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia – name: 1 Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia – name: 5 Department of Nursing, Tibebe Gion Specialized Hospital, Bahir Bar University, Bahir Bar University, Bahir Dar, Ethiopia – name: 6 Department of Pediatrics and Child Health Nursing, College of Health Sciences, Injibara University, Injibara, Ethiopia – name: 7 Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia – name: Hawassa University College of Medicine and Health Sciences, ETHIOPIA – name: 4 Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia – name: 3 Department of Pediatrics and Child Health Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia |
| Author_xml | – sequence: 1 givenname: Amare orcidid: 0000-0003-1321-9151 surname: Kassaw fullname: Kassaw, Amare – sequence: 2 givenname: Demewoz surname: Kefale fullname: Kefale, Demewoz – sequence: 3 givenname: Tigabu Munye surname: Aytenew fullname: Aytenew, Tigabu Munye – sequence: 4 givenname: Molla surname: Azmeraw fullname: Azmeraw, Molla – sequence: 5 givenname: Muluken Chanie surname: Agimas fullname: Agimas, Muluken Chanie – sequence: 6 givenname: Shegaw surname: Zeleke fullname: Zeleke, Shegaw – sequence: 7 givenname: Mastewal Ayehu surname: Sinshaw fullname: Sinshaw, Mastewal Ayehu – sequence: 8 givenname: Nigatu surname: Dessalegn fullname: Dessalegn, Nigatu – sequence: 9 givenname: Worku Necho orcidid: 0000-0002-1886-3707 surname: Asferie fullname: Asferie, Worku Necho |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/39509354$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | Copyright: © 2024 Kassaw et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. COPYRIGHT 2024 Public Library of Science 2024 Kassaw et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2024 Kassaw et al 2024 Kassaw et al 2024 Kassaw et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
| Copyright_xml | – notice: Copyright: © 2024 Kassaw et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. – notice: COPYRIGHT 2024 Public Library of Science – notice: 2024 Kassaw et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. – notice: 2024 Kassaw et al 2024 Kassaw et al – notice: 2024 Kassaw et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
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| DOI | 10.1371/journal.pone.0312698 |
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| Snippet | Human immunodeficiency virus (HIV) and tuberculosis (TB) are still the two major deadly pandemics globally, causes 167,000 deaths in 2022. The two lethal... Background Human immunodeficiency virus (HIV) and tuberculosis (TB) are still the two major deadly pandemics globally, causes 167,000 deaths in 2022. The two... BackgroundHuman immunodeficiency virus (HIV) and tuberculosis (TB) are still the two major deadly pandemics globally, causes 167,000 deaths in 2022. The two... Background Human immunodeficiency virus (HIV) and tuberculosis (TB) are still the two major deadly pandemics globally, causes 167,000 deaths in 2022. The two... |
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| SubjectTerms | Acquired immune deficiency syndrome AIDS Analysis Anemia Antiretroviral therapy Antitubercular agents Antitubercular Agents - therapeutic use Biology and Life Sciences Care and treatment CD4 antigen Coinfection - epidemiology Coinfection - mortality Collaboration Comorbidity Cotrimoxazole Diagnosis Disease Dosage and administration Ethiopia Ethiopia - epidemiology Heterogeneity HIV HIV (Viruses) HIV Infections - complications HIV Infections - epidemiology HIV Infections - mortality HIV patients Human immunodeficiency virus Humans Immobilization Immune system Immunity (Disease) Infections Isoniazid Medical Subject Headings-MeSH Medicine and Health Sciences Medicine, Preventive Meta-analysis Methods Missing data Mortality Pandemics Patient outcomes Patients People and Places Physical Sciences Preventive health services Public health Research and Analysis Methods Risk factors Search strategies Sensitivity analysis Software Statistical analysis Statistical tests Sub-Saharan Africa Systematic review Tanzania Tuberculosis Tuberculosis - complications Tuberculosis - epidemiology Tuberculosis - mortality |
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| Title | Burden of mortality and its predictors among TB-HIV co-infected patients in Ethiopia: Systematic review and meta-analysis |
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