Int
ern
at
i
onal
Journ
al of
P
u
bli
c Hea
lt
h S
c
ie
nce (IJPH
S)
Vo
l.
6
,
No.
3
,
S
eptem
ber
201
7
, pp.
26
6
~
27
4
IS
S
N:
22
52
-
8806,
DOI: 10
.11
591/
ij
phs
.
v6
i
3.
9
294
266
Journ
al h
om
e
page
:
https:
//
ww
w.i
aesco
re
.c
om
/j
our
nals/
ind
ex.
php/IJP
H
S
Incidenc
e and Pr
edictors
of
Tub
er
culosis
a
mong
A
du
lt
PLWHA
at
Pub
lic
Hea
lth
Fac
iliti
es of H
awassa Cit
y
Henok Be
kele
1
, M
es
fin
Kote
2
, A
m
an Yes
uf
3
,
Tadele
Giru
m
4
1
Depa
rtment of
Quali
t
y
As
suran
ce
,
Adare
Hos
pital
,
Southern
Reg
ion
Hea
lt
h
Bure
au
,
H
awa
ss
a
,
Ethiopia
2
,3
Depa
rtment
of
Public Health,
Coll
ege
of
Medi
ci
ne
and
Hea
l
th S
ci
ences
,
Arba
Minch
Univer
si
t
y
,
Arba
Minch
,
Et
hiopia
4
Depa
rtment
of
Public
He
al
th
,
C
oll
eg
e
of
Medici
ne
and
Hea
lt
h
Sc
ie
nc
es
,
W
olkite
Univer
sit
y
,
W
ol
kit
e
,
E
thi
opi
a
Art
ic
le
In
f
o
ABSTR
A
CT
Art
ic
le
history:
Re
cei
ved
J
un
8, 20
17
Re
vised A
ug 11, 2
017
Accepte
d Aug
2
8
, 201
7
Tube
rcu
losis
(T
B)
is
the
m
ost
fre
quentl
y
dia
gn
osed
opportuni
st
ic
infect
ion
(OI)
and
dise
ase
in
p
eople
l
iving
with
HIV
/AIDS
(PLW
H
A),
world
-
wide
.
Thi
s
stud
y
ai
m
e
d
at
d
et
ermining
the
in
ci
d
ence
a
nd
pre
dictors
of
tube
rcu
losis
among
peopl
e
living
with
HIV
.
A
Six
y
ea
r
r
et
ro
spec
ti
v
e
foll
ow
up
stud
y
was
conduc
t
ed
among
adul
t
PLHIV
.
The
Cox
proporti
onal
h
azards
m
odel
was
used
to
ide
nt
if
y
pre
d
ictors
.
A
tot
al
of
554
pat
i
ent
s
were
f
oll
owed
an
d
produc
ed
1830
.
3
per
son
y
ear
of
observa
ti
on
.
On
e
hundre
d
six
t
y
one
new
TB
ca
ses
oc
cur
red
d
uring
the
foll
ow
up
per
iod
.
The
over
all
in
ci
den
c
e
density
of
TB
was
8.
79
p
e
r
100
per
son
-
y
e
ar
(PY
).
It
w
as
high
(148.
71/10
0
PY
)
in
th
e
first
y
ea
r
of
enr
olment.
Th
e
cu
m
ula
ti
ve
propor
t
ion
of
TB
fre
e
survival
was
79%
and
67%
a
t
the
end
of
f
irst
and
sixth
y
ear
s,
res
pectivel
y
.
Not
havi
ng
form
al
educat
io
n(AH
R=2.
68,
9
5%CI:
1.
41,
5.
1
1
),
base
li
ne
W
HO
cl
ini
cal
stage
IV
(
AH
R
=
3.
22
,
95
%
CI=1.
91
-
5
.
4
1),
CD4
count
<50
c
el
l
/u
l
(AH
R=2.
41,
95%CI=
1.
31,
4
.
42),
Bei
ng
bed
red
den
(AH
R=
2.
89,
95%CI=
1.
72,
3.
78),
past
TB
h
istor
y
(AH
R=
1.
65,
95%
CI
=
1.
06,
2
.
39)
,
subs
ta
nce
use
(
AH
R=1.
46,
95
%
CI=1.
03
,
2.
06
)
and
b
ei
ng
on
pre
AR
T
(AH
R=1.
62
,
95
%CI:
1.
03
-
2
.
54
)
were
inde
p
end
ent
l
y
p
red
i
c
te
d
t
uber
cul
osis
occ
urre
n
ce.
Advanc
ed
W
HO
cl
in
ic
a
l
stage,
li
m
ite
d
func
ti
on
al
sta
t
us,
past
TB
histor
y
,
addicti
o
n
and
low
CD4
(<50c
e
ll
/u
l)
cou
nt
at
e
nroll
m
en
t
were
found
to
be
th
e
ind
ependent
pre
d
ictor
of
tube
rcu
losis
occ
urre
n
ce.
Th
e
ref
ore
ea
r
l
y
ini
tiati
on
of tre
atm
ent
and
intensi
ve
fol
low
up
is im
porta
nt.
Ke
yw
or
d:
Haw
as
sa
HIV
i
nfe
ct
io
n
Pr
e
dictors
Tu
ber
c
ulo
sis
i
ncide
nce
Copyright
©
201
7
Instit
ut
e
o
f Ad
vanc
ed
Engi
n
ee
r
ing
and
S
cienc
e
.
Al
l
rights re
serv
ed
.
Corres
pond
in
g
Aut
h
or
:
Tadele
Giru
m
,
Dep
a
rtm
ent o
f Pu
blic
Healt
h
,
Coll
ege
of
Me
dicine a
nd H
e
a
lt
h
Scie
nces
,
Wo
l
kite
U
niv
e
rsity
,
Wo
lkit
e,
Ethio
pia.
Em
a
il
: giru
m
tad
el
e@ya
ho
o.
c
om
1.
INTROD
U
CTION
Hu
m
an
i
m
m
u
node
fici
ency
vir
us
(
HIV)
infecti
on
is
the
great
est
r
isk
facto
r
f
or
acq
uiring
My
cob
act
eriu
m
tub
erc
ulo
si
s
infecti
on
an
d
de
velo
ping
tub
e
rcu
l
os
is
(
TB)
[
1].
Tu
be
rcu
l
os
is
is
th
e
m
os
t
fr
e
qu
e
ntly
diagnose
d
op
port
un
ist
ic
infecti
on
(
OI)
an
d
dis
ease
in
pe
op
le
li
vin
g
with
H
IV
/A
I
DS
(
PL
WHA),
world
-
wi
de
[
2]
.
Des
pite
bei
ng
pre
ven
ta
ble
it
is
sti
ll
a
le
adi
ng
c
ause
of
m
orbidity
an
d
m
or
ta
li
ty
in
PL
WHA.
At
le
ast
one
i
n
f
our
deat
hs
a
m
on
g
PL
WH
A
ca
n
be
at
tri
bu
te
d
to
TB
a
nd
m
any
of
th
ese
deat
hs
occ
ur
i
n
dev
el
op
i
ng
c
ount
ries,
li
ke
A
fr
ic
an
c
ountrie
s
[3
]
.
H
IV
po
s
it
ive
peo
ple
w
it
h
la
te
nt
TB
i
nf
ect
io
n
ha
ve
a
10
%
annual
a
nd
50
%
li
fetim
e
risk
of
de
velo
ping
act
ive
TB
di
sease,
op
pose
d
to
10%
of
li
fe
ti
m
e
risk
of
H
I
V
neg
at
ive
i
nd
i
vi
du
al
s
[4
]
.
As
a
resu
lt
,
TB
bec
om
es
a
m
ajo
r
public
healt
h
pro
blem
,
par
ti
cularly
in
area
wh
e
re
HIV
in
fecti
on
rates
is
highe
r
[
5].
Gl
ob
al
l
y
1.
2
m
il
li
on
(12%
)
of
9.6
m
illi
on
pe
ople
who
dev
el
oped
T
B
(incide
nce
)
we
re
H
IV
posit
ive
in
20
14.
A
m
on
g
these
74%
H
I
V
posit
ive
TB
cases
wer
e
in
A
fr
ic
a
.
Ev
e
n
though
the
nu
m
ber
of
pe
ople
dyin
g
from
HI
V
ass
ociat
ed
TB
in
la
st
dec
ade
decr
ea
ses,
it
kill
s
25%
(390,00
0)
of
al
l
TB
deat
hs
a
nd
one
thir
d
of
the
est
im
a
te
d
1.2
m
il
l
ion
deaths
from
HIV/A
IDS
[
6].
A
cco
r
ding
to
World
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
In
ci
den
ce
an
d Predict
or
s
o
f
T
ub
e
rcul
os
is
among Ad
ult P
L
WHA at P
ubli
c H
e
alth
.... (H
eno
k
Bekel
e)
267
Ba
nk
repor
t,
people
w
ho
are
la
te
ntly
infected
with
m
yc
ob
act
eri
um
tub
e
rcu
l
os
is
(
about
one
thi
rd
of
inh
a
bitants
of
Sub
-
Sa
ha
ran
A
fr
ic
a)
are
at
gr
eat
er
ris
k
of
de
velo
ping
act
iv
e
TB,
th
ey
are
al
so
im
m
un
ologica
ll
y
week
e
nd
by concu
rr
e
nt
HIV i
nf
e
ct
io
n [7
]
,
[8
]
.
Ethio
pia
is
on
e
of
22
Worl
d
high
bur
de
n
c
ountries
of
TB
,
ra
nkin
g
se
ve
nth
a
nd
am
ong
to
p
five
in
Africa
[
9]. A
cc
ordin
g
to
W
H
O
global
TB
re
port
of 2015
th
e
co
un
t
ry
ha
d
est
i
m
at
ed
200,000
TB
cases
i
n
2014
with
a
n
est
im
a
te
d
incide
nce
r
at
e
of
207
c
ase
s
pe
r
10
0,000
popula
ti
on
s
[
6].
I
n
re
cent
ye
ar
s,
great
ef
f
or
ts
have
been
m
ade
to
integ
rate
TB
di
agnosis
a
nd
tre
atm
ent
into
HIV
care
wh
ic
h
he
lps
especial
ly
to
pr
e
ve
nt
dia
gnos
i
s
and
treat
TB
a
m
on
g
pe
ople
with
HIV
a
nd
HIV
am
ong
T
B
patie
nts.
Thi
s
has
create
d
t
he
c
han
ce
to
a
dd
it
io
nal
researc
h
f
or
be
tt
er
under
sta
ndin
g
of
fa
ct
ors
associat
ed
with
incide
nce
of
TB
wh
ic
h
co
uld
hel
p
to
i
m
pro
ve
serv
ic
e
qual
it
y.
T
her
e
fore
th
e
outc
om
e
of
this
stu
dy
pr
ovide
i
nfor
m
at
i
on
ab
out
ris
k
factors
or
t
he
m
os
t
influ
e
ntial
covariat
e
s
that
hav
e
sig
nificant
im
pact
on
incid
ence
of
TB
an
d
identify
TB
incidenc
e
rate
unde
r
tho
se
si
gn
i
ficant
facto
rs
at
diff
e
ren
t
ti
m
e
a
m
on
g
H
IV
i
nfect
ed
patie
nts
durin
g
ART
ca
re,
wh
ic
h
ca
n
be
use
d
to d
e
sig
n
a
ppr
opriat
e act
ion t
o red
uce t
he
oc
currence
of TB
am
on
g HIV
pa
ti
ents.
2.
METHO
DS
A
ND M
ATERI
ALS
2.1.
St
ud
y desi
gn
an
d
setti
ngs
A
six
ye
ars
in
sti
tuti
on
base
d
retro
s
pecti
ve
fo
ll
ow
-
up
stu
dy
was
cond
uct
ed
in
th
ree
hea
lt
h
facil
it
ie
s
(H
a
wassa
U
niv
ersit
y
refe
r
ral
Hospita
l,
A
da
re
ge
neral
hospi
ta
l
and
m
i
ll
enn
ium
healt
h
center)
w
hich
a
re
fou
nd
in
Haw
ass
a
ci
ty
,
south
Ethi
opia
.
T
he
ci
ty
ha
s
35
1,656
tot
al
popula
ti
on
s
orga
nized
i
n
s
ub
ci
ti
es;
an
d
has
one
public
ref
e
rr
al
ho
s
pital
,
one
public
ge
ner
al
ho
sp
it
al
,
10
go
ve
rn
m
ental
healt
h
centers,
4
pri
vate
hosp
it
al
s
and
about
36
pr
iv
a
te
cl
inics.
Ha
wassa
unive
rsi
ty
ref
er
ral
hos
pital
is
te
achi
ng
re
ferral
hosp
it
al
.
T
he
HIV
ca
re
serv
ic
e
of
t
he
ho
s
pital
s
was
init
ia
te
d
at
20
05
a
nd
ha
s
th
r
ee
cl
inics;
ad
ul
t
ART,
pe
di
at
ric
ART
a
nd
VCT
cl
inics
w
hich
a
ll
ow
ed
to
offe
r
ed
fr
ee
ART
s
erv
ic
es.
All
fa
ci
li
ti
es
us
es
na
ti
on
al
sta
nda
rdi
zed
m
on
it
or
in
g
a
nd
evaluati
on
to
ol
s,
an
d
the
dat
a
colle
ct
ion
a
nd
m
anag
em
ent
processes
are
well
co
ntro
ll
e
d
an
d
s
uppo
rted
by
el
ect
ro
nic
data
back
-
up
a
nd
proces
sin
g.
T
he
re
we
re
ab
out
a
total
5,642a
nd
4,4
10
cl
ie
nts
who
e
ver
sta
rted
an
d
currently
on A
RT res
pecti
vel
y i
n
the t
hr
ee
s
el
ect
ed
facil
it
ie
s.
2.2.
St
ud
y po
pula
t
ion
an
d
sampl
ing
techniq
ue
The
S
ource
po
pu
la
ti
on
we
re
Adults
(
≥
15
y
ear)
li
vi
ng
with
H
IV
w
ho
ev
er
re
gistere
d
to
chro
nic
HIV
care
an
d
s
upport
program
in
the
facil
it
ie
s.
All
avail
able
554
c
ha
rts
in
th
e
three
hosp
it
a
ls
that
enroll
ed
from
Septem
ber
1,
2009
to
A
ugust
31
,
20
10,
w
ere
inclu
ded
i
n
the
stud
y.
T
ho
s
e
patie
nts
with
m
issi
ng
char
t
or
incom
plete
bas
e li
ne
an
d f
ollo
w up data
we
re
ex
cl
ude
d.
2.3.
Data c
ollec
tio
n p
r
ocedure
s
an
d
too
ls
All
avail
able
i
nfor
m
at
ion
on
patie
nt
rec
ords
was
chec
ke
d
and
an
a
pprop
r
ia
te
data
ext
ra
ct
ion
form
at
was
pr
e
pa
red
in
E
ng
li
s
h.
Th
en,
data
was
e
xtracted
f
ro
m
patie
nts’
cha
rt
s
by
f
our
trai
ne
d
nurses
w
ho
ha
d
add
it
io
nal
AR
T
trai
ning
an
d
ex
per
ie
nce
in
HIV
care
.
Tw
o
data
cl
er
k
was
us
e
d
to
sup
port
nur
ses
by
identify
in
g
th
e
cha
rts.
C
har
ts
wer
e
retrie
ved
us
in
g
t
he
patie
nt’s
re
gistrati
on
nu
m
ber
w
hic
h
was
f
ound
in
data
base i
n
el
ect
r
onic
sy
ste
m
.
2.4.
Data pr
ocessi
ng
and
analys
is
Data
was
c
hec
ked
f
or
it
s
c
onsist
ence
an
d
c
om
ple
te
ness;
th
en
e
ntered
into
a
com
pu
te
r
usi
ng
E
PI
i
nfo
ver
si
on
7
a
nd
then
ex
porte
d
t
o
the
SP
SS
ve
rsion
20
f
or
a
na
ly
sis.
Data
w
as
enter
ed
by
pr
i
ncipal
in
ves
ti
gator
and
clea
ne
d
be
fore an
al
ysi
s.
Su
m
m
ary
stat
i
sti
cs w
as carr
ie
d
out t
o
descr
i
be
dem
og
ra
phic
, b
asel
ine and
f
ollo
w
up
data.
I
ncid
ence
Ra
te
(I
R
)
w
as
cal
culat
ed
for
e
ntire
stud
y
per
i
od.
Life
ta
ble
wa
s
us
e
d
t
o
est
i
m
at
e
cum
ulati
ve
su
rv
i
val
(TB
fr
e
e)
of
PL
WHI
V.
The
Kap
la
n
-
Me
ie
r
cu
r
ve
was
us
ed
to
est
i
m
at
e
the
m
edian
durati
on
of
T
B
occurre
nce.
Lo
g
ra
nk
te
s
t
was
us
e
d
to
com
par
e
sur
viv
al
cu
r
ves
be
tween
the
di
ff
e
rent
cat
egories o
f
e
xp
la
nato
ry v
a
ri
ables.
Both
biv
a
riat
e
and
m
ulti
ple
c
ox
pro
portio
na
l
hazar
d
m
od
el
wer
e
us
e
d
t
o
identify
t
he
pre
dictors
.
T
he
var
ia
bles
wit
h
P
val
ue
<
0.2
5
in
the
bi
var
ia
t
e
analy
sis
we
r
e
entere
d
t
o
m
ulti
ple
pro
porti
on
al
haza
rd
m
od
el
s
.
95%
c
onfide
nc
e
inter
val
of
adjuste
d
hazar
d
rati
o
was
c
om
pu
te
d
an
d
va
riables
ha
ving
p
value
<
0.0
5
in
m
ul
ti
ple
propor
ti
onal
hazar
ds
m
od
el
wa
s
co
ns
ide
red
a
s
sig
nificantl
y
an
d
in
de
pend
ently
associat
ed
with
dep
e
ndent
va
r
ia
bles.
T
he
ne
cessary
ass
um
pt
ion
of
c
ox
pro
portio
nal
haza
rd
m
od
e
l
was
c
hec
ke
d
us
in
g
Schoen
fiel
d re
sidu
al
test
a
nd
gr
a
phic
al
ly
.
2.5.
Ethical
ap
pr
oval
Ethic
al
cl
earan
ce
was
o
btaine
d
from
rev
ie
w
boar
d
of
A
r
ba
Mi
nch
U
nive
rsity
Coll
ege
of
m
edici
ne
and
healt
h
sc
ie
nce
with
a
ref
e
ren
ce
CM
HS
/P
G/130/
08
.
Let
te
r
of
pe
rm
issi
on
was
obta
ined
f
rom
the
m
anag
em
ent
(CEO)
of
t
he
hosp
it
al
s.
T
he
he
ad
of
the
HIV
care
cl
inics
w
as
giv
i
ng
t
he
c
on
s
ent
f
or
extr
act
ing
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,
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ber
201
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–
27
4
268
data
from
records.
Pati
ent
na
m
es
and
ide
ntific
at
ion
nu
m
ber
s
was
not
extr
act
ed
so
as
t
o
ens
ur
e
c
onfide
ntial
it
y
of p
at
ie
nt i
nform
at
ion
.
3.
RESU
LT
S
Am
on
g,
554
pa
ti
ents
rem
a
ining
in
t
he
anal
ysi
s,
the
m
ean
age
was
34.48
+/
-
9.1
4
an
d
alm
os
t
half,
267
(
48.
2%)
of
them
wer
e
in
the
age
gro
up
25
-
34
ye
a
rs.
Mo
re
than
half
324(5
8.5%)
of
P
LHIV
wer
e
fe
m
al
es
and
337(6
.8%)
wer
e
O
rth
od
ox
C
hr
ist
ia
n.
Abo
ut
259
(
46.
8
%)
of
the
par
ti
ci
pan
ts
wer
e
m
arr
ie
d
and
207
(37.4%
)
ha
ve
on
ly
pri
m
ary
l
evel
of
e
ducat
ion.
More
t
ha
n
half
of
the
n
31
5(5
6.7%)
wer
e
hav
e
occupati
on
i
n
diff
e
re
nt
le
vel
of
w
ork
sta
tus.
Ma
j
or
it
y,
499(9
0.1%
),
of
the
patie
nts
ca
m
e
fr
om
ur
ba
n
areas.
A
total
of
48
7
(87.9%
)
patie
nt
s
had
d
isc
lose
d
their H
I
V
sta
tus
to
ei
ther
t
he
ir
fam
ily,
or
ot
her
relat
ives
. Mo
st
o
f
t
he
ti
m
e
they
disclose
d
to
their
wife/
hus
band
a
nd
brothe
r/sist
er
w
hich
acc
ounte
d
19
1
(
34.5
%)
an
d
11
2(20.2%)
resp
ect
ively
.
T
wo
hu
ndre
d
tw
enty
six (40.
8%
) of t
he pati
ents we
re
substa
nce
us
er
s
as
show
n
i
n
Ta
ble
1
.
Table
1
.
Ba
sel
i
ne
S
oc
io
D
em
ogra
ph
ic
C
har
a
ct
erist
ic
s o
f
PL
HIV
on
Ch
roni
c
H
IV
Ca
re
a
t
Haw
as
sa
City
Ch
arac
teristics
Nu
m
b
e
r/f
requ
en
cy
Percent
Ag
e
15
-
24
45
8
.1
25
-
34
267
4
8
.2
35
-
44
155
2
8
.0
≥4
5
87
1
5
.7
Sex
Male
230
4
1
.5
Fe
m
ale
324
5
8
.5
Mar
ital
statu
s
Sin
g
le
87
1
5
.7
Mar
ried
259
4
6
.8
Div
o
rced
125
2
2
.2
wid
o
wed
83
15
Relig
io
n
Ortho
d
o
x
337
6
0
.8
Mus
li
m
39
7
Protes
tan
t
168
3
0
.3
Cath
o
lic
10
1
.8
Level o
f
edu
catio
n
No
edu
catio
n
105
19
Pri
m
a
r
y
207
3
7
.4
Seco
n
d
ary
166
30
Ter
tia
ry
76
1
3
.7
Occup
atio
n
Yes
313
5
6
.9
No
231
4
3
.1
Ad
d
ress
Urban
499
9
0
.1
Ru
ral
55
9
.9
Disclo
su
re
Disclo
sed
484
8
7
.8
No
t dis
clo
sed
67
1
2
.2
Su
b
stan
ce us
e
Used
226
41
No
t us
ed
324
59
Fa
m
il
y
size
<2
296
5
3
.8
3
-
4
201
3
6
.6
>5
53
9
.6
The
el
igibil
it
y
crit
erio
n
f
or
i
niti
at
ion
of
H
AA
RT
was
m
ai
n
ly
CD4
cel
l
count
in
316(5
7%
).
T
he
pr
e
dom
inant
reg
im
ents
init
ially
pr
escribe
d
wer
e
a
c
om
bin
at
ion
of
zi
dovudi
ne,
Lam
ivudine
a
nd
Nev
i
rap
i
ne
(1
c
)
197(3
5.6
%)
fo
ll
owe
d
by
Stavu
di
ne,
L
a
m
ivu
din
e a
nd Ef
avire
nz
(
1d)
(
19.9%). One hun
dr
e
d
f
or
ty
(
25.6%)
patie
nts
ha
d
c
ha
ng
e
d
thei
r
ini
ti
al
reg
i
m
en
duri
ng
t
he
f
ollo
w
up
per
i
od
m
ai
nly
to
a
com
bin
at
io
n
of
Ti
nof
ovir,
Lam
ivu
di
ne
an
d
Efa
vire
nz
(
1e
)
85
(15.3%
).
On
ly
4(0.7%
)
patie
nts
wer
e
switc
he
d
to
se
cond
li
ne
H
A
ART.
The
pr
e
do
m
inant
reas
on
f
or
changin
g
t
he
init
ia
l
reg
im
en
was
drug
side
eff
ect
11
7(2
1.1%)
a
nd
f
ollo
wed
by
tub
e
rcu
l
os
is
6(1.1%)
.
Half
of
the
re
gim
en
was
c
ha
ng
e
d
within
the
first
two
ye
ar
of
fol
low
up
per
i
od.
A
bout
three
fou
rth
(73.6%)
of
them
wer
e
on
w
ork
ing
functi
onal
sta
tus
at
baseli
ne.
T
w
o
hundr
ed
tw
o
(36.4%
)
an
d
on
e
hundre
d
ei
gh
ty
ei
gh
t
(33.9%)
of
the
par
ti
ci
pa
nts
w
ere
at
WH
O
c
li
nical
sta
ge
t
wo
a
nd
th
ree
durin
g
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IJPHS
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In
ci
den
ce
an
d Predict
or
s
o
f
T
ub
e
rcul
os
is
among Ad
ult P
L
WHA at P
ubli
c H
e
alth
.... (H
eno
k
Bekel
e)
269
enrolm
ent
resp
ect
ively
.
T
he
m
edian
CD4
count
durin
g
enroll
m
ent
and
e
nd
of
f
ollo
w
up
wa
s
2
03
[IQR:
117
-
32
1] an
d 5
25[IQR:
368
-
696.5]
res
pecti
ve
l
y as sh
own
i
n
Ta
ble
2
.
Table
2
.
Ba
sel
i
ne
Cl
inica
l
an
d
Im
m
un
ologica
l Sta
tu
s
of
PL
HIV
on
C
hro
nic
HIV
Ca
re
s
at
Ha
wassa cit
y
Ch
arac
teristics
Nu
m
b
er
Percent
ART eligib
ility
cr
i
teria
CD4
cou
n
t
314
57
W
HO
clinical st
ag
e
69
1
2
.5
Bo
th
168
3
0
.5
Initial
regi
m
en
1
a(30
)
100
1
8
.1
1
a(40
)
89
1
6
.1
1
b
(30
)
6
1
.1
1
b
(40
)
43
7
.8
1c
7
1
.3
1d
197
3
5
.6
1e
110
1
9
.9
Oth
er
2
0
.4
Reg
i
m
en
chan
g
e
Yes
142
2
5
.6
No
412
7
4
.4
New reg
i
m
en
1
b
(40
)
2
0
.4
1c
3
6
1d
16
2
.9
1e
85
1
5
.3
Oth
er
4
0
.7
Reas
o
n
f
o
r
ch
an
g
e
Sid
e eff
ect
117
2
1
.1
Pregn
an
cy
4
0
.7
TB
6
1
.1
No
t r
ecord
ed
4
0
.7
Oth
er
11
2
.7
Past TB his
to
r
y
Yes
79
1
4
.4
No
426
7
7
.3
No
t r
ecord
ed
44
8
.3
Fu
n
ctio
n
al statu
s
W
o
rkin
g
405
7
3
.6
A
m
b
u
lato
ry
128
2
3
.1
Bed
ridd
en
16
2
.9
W
HO
clinical st
ag
e
I
121
2
1
.8
II
202
3
6
.5
III
188
3
3
.9
IV
43
7
.8
CD4
cou
n
t
<5
0
38
6
.9
51
-
150
140
2
5
.3
151
-
2
5
0
169
3
0
.5
251
-
3
5
0
82
1
4
.8
>3
5
0
125
2
2
.6
3.1.
Tuberc
ulosis
inci
dence de
ns
ity
Five
hundre
d
f
ifty
four
stu
dy
par
ti
ci
pa
nts
w
ere
f
ollo
wed
f
or
dif
fer
e
nt
p
e
rio
ds
f
or
six
ye
ars
wh
ic
h
gav
e
us
18
30.
33
per
s
on
ye
ar
s
of
obse
rv
at
i
on.
W
it
hi
n
the
f
ollow
up
per
i
od,
16
1
ne
w
tu
be
rcu
l
os
is
cases
wer
e
ob
s
er
ved.
He
nc
e,
the
ov
e
rall
TB
incidence
densi
ty
rate
(I
DR)
in
the
co
hort
was
8.7
9
pe
r
100
Per
son
Year
s
.
Stud
y
par
ti
ci
pa
n
ts
we
re
f
ollo
wed
for
a
m
ini
m
u
m
of
1
m
onth
an
d
a
m
axi
m
u
m
of
72
m
on
ths
.
The
m
ean
f
ollo
w
up
per
i
od
was
39.5
m
on
ths
.
Of
the
i
ncid
ent
TB
cases,
137(2
4.7%)
wer
e
P
ulm
on
a
ry
Tu
ber
c
ulo
si
s
an
d
24(
4.3%)
wer
e
Extra
-
P
ulm
on
ary
or
/a
nd
Dis
sem
inate
d
Tu
be
rcu
l
os
is.
On
e
hundre
d
fi
fteen
(
71.42%
)
of
the
TB
cases
wer
e
occ
urred
within
th
e
first
ye
ars
of
fo
ll
ow
up.
T
he
highest
incide
nce
rate
of
TB
was
obse
rv
e
d
i
n
the
first
ye
ar
of
en
ro
lm
ent
(1
48.
71/1
00
PY)
an
d
then
dec
rease
d
in
the
s
ubseq
uen
t
ye
ars
of
f
ollow
up
(
19.03
an
d
0.8
per
10
0PY
in
three
and
sixth
ye
ars
res
pecti
vely
).
Si
m
il
arly
the
nu
m
ber
of
TB
incidence
am
on
g
ART
sta
rted
patie
nts
was
dec
rease
d
cr
os
se
d
the
f
ollow
up
pe
rio
d.
T
his
in
direc
tl
y
rev
eal
ed
th
at
reducti
on
s
i
n
TB
incidenc
e
rate
fo
ll
owin
g
t
he
sta
y
on
HAAR
T.
B
ut
the
hi
ghe
st
nu
m
ber
of
TB
incide
nt
was
obser
ve
d
on
the
new
ly
ART
sta
rted
patie
nts.
T
he
cum
ulati
ve
pro
bab
il
it
y
of
TB
su
r
viv
al
at
the
en
d
of
one ye
ar,
tw
o
ye
ar,
three
Evaluation Warning : The document was created with Spire.PDF for Python.
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IJPHS
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Septem
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6
–
27
4
270
ye
ar,
f
our
ye
a
r
an
d
si
x
ye
ar
was
0.79,
0.7
5,
0.71
an
d
0.67
res
pecti
vel
y.
The
m
edian
su
r
viv
al
ti
m
e
fro
m
enrolm
ent to ch
r
onic
HIV
car
e to TB
occ
urr
ence is
60 m
onths
(
Table
3
a
nd
Fi
gure
1).
Tab
le
3
.
T
uber
culosis
I
ncide
nc
e D
e
ns
it
y R
at
e Strati
fied
b
y
So
ci
o
-
dem
og
ra
ph
ic
C
har
act
e
risti
cs
of PL
HIV
who
w
e
re
on Ch
ronic H
I
V
Ca
re
in Hawas
sa Ci
ty
Ch
arac
teristics
Total
PY of
O
b
serv
atio
n
TB
TB I
DR/1
0
0
PY
Ag
e
15
-
24
45
1
6
0
.41
10
6
.23
25
-
34
267
8
7
2
.67
79
9
.04
35
-
44
155
5
3
2
.67
40
7
.50
≥4
5
87
2
6
3
.58
32
1
2
.14
Sex
Male
230
7
6
5
.34
67
8
.75
Fe
m
ale
324
1
,06
5
94
8
.82
Mar
ital
statu
s
Sin
g
le
87
2
6
7
.41
33
1
2
.34
Mar
ried
259
8
6
6
.00
74
8
.54
Div
o
rced
125
3
8
8
.91
32
8
.22
W
id
o
wed
83
3
0
8
.00
22
7
1
.42
Relig
io
n
Ortho
d
o
x
337
1
0
7
0
.7
106
9
.90
Mus
li
m
39
1
3
0
.08
16
1
2
.30
Protes
tan
t
168
5
9
8
.70
37
6
.18
Cath
o
lic
10
3
2
.52
2
6
.15
Level o
f
edu
catio
n
No
edu
catio
n
105
2
8
6
.50
34
1
1
.86
Pri
m
a
r
y
207
6
8
3
.58
65
9
.5
Seco
n
d
ary
166
5
7
4
.75
48
8
.35
Ter
tia
ry
76
2
8
5
.50
14
4
.9
Occup
atio
n
Yes
313
1
0
6
4
.0
8
85
7
.98
No
238
7
6
6
.25
76
9
.91
Ad
d
ress
Urban
499
1
6
5
3
.9
1
145
8
.76
Ru
ral
55
1
7
6
.41
16
9
.06
Disclo
su
re
Disclo
sed
484
1
6
4
0
.0
8
147
8
.96
No
t dis
clo
sed
67
1
9
0
.25
14
7
.35
Su
b
stan
ce us
e
Used
*
226
1
1
9
3
.1
6
83
6
.95
No
t us
ed
325
6
3
7
.16
78
1
2
.24
ART eligib
ility
cr
i
teria
CD4
cou
n
t
314
1
1
8
6
.1
6
72
6
.07
W
HO
clinical st
ag
e
69
2
2
1
.41
12
5
.41
Bo
th
168
4
2
3
.91
77
1
8
.16
Initial
regi
m
en
1
a(30
)
100
2
8
6
.33
31
1
0
.82
1
a(40
)
89
3
2
.16
0
0
.00
1
b
(30
)
8
1
0
3
.16
23
2
2
.29
1
b
(40
)
43
2
7
.91
3
1
0
.74
1c
7
7
0
7
.58
38
5
.37
1d
197
3
4
4
.41
34
9
.87
1e
110
3
2
5
.41
32
9
.83
Past TB his
to
r
y
Yes
79
1
9
0
.00
46
2
4
.21
No
426
1
3
1
7
.8
2
102
7
.74
No
t
recorded
44
1
6
7
.91
13
7
.74
Fu
n
ctio
n
al statu
s
W
o
rkin
g
405
1
5
3
1
.1
9
81
5
.29
A
m
b
u
lato
ry
127
2
7
9
.58
68
2
4
.32
Bed
ridd
en
16
2
7
.5
12
5
5
.81
W
HO
clinical st
ag
e
I
121
5
2
6
.84
21
3
.98
II
202
7
0
9
.16
47
6
.62
III
188
5
2
4
.25
61
1
1
.63
IV
43
7
0
.08
32
4
5
.64
CD4
co
u
n
t
<5
0
38
1
0
7
.50
18
1
6
.74
51
-
150
140
4
1
4
.16
55
1
3
.27
151
-
2
5
0
169
5
4
4
.75
48
8
.81
251
-
3
5
0
82
2
6
9
.50
15
5
.56
>3
5
0
125
4
9
4
.41
25
5
.05
Year
of
f
o
llo
w up
≤1
161
7
7
.33
115
1
4
8
.71
1
-
3
85
1
6
8
.08
32
1
9
.03
≥3
311
1
5
8
6
.9
2
11
0
.8
Enro
l
m
en
t statu
s
Pre
AR
T
422
1
4
0
2
.5
0
135
9
.70
ART
129
4
2
7
.83
26
6
.07
*
Su
b
stan
ce us
ed
m
eans
tho
se wh
o
us
ed
at
least o
n
e of
t
h
e f
o
llo
win
g
alcohol, tob
acco o
r
d
rug
s
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
In
ci
den
ce
an
d Predict
or
s
o
f
T
ub
e
rcul
os
is
among Ad
ult P
L
WHA at P
ubli
c H
e
alth
.... (H
eno
k
Bekel
e)
271
Figure
1
.
Kap
l
an
-
Me
ie
r
curve
of TB
-
fr
ee
s
urvival
pro
portio
n for P
LH
IV
on
ch
r
on
ic
HIV ca
re at
healt
h faci
li
ti
es f
ound in Ha
wassa
ci
ty
3.2.
Predi
cto
r
s
of
t
im
e to TB
o
cc
urrence
In
the
m
ulti
ple
Co
x
-
regressio
n
a
naly
sis
le
ve
l
of
ed
ucati
on,
su
bst
ance
us
e
, p
ast
TB histo
r
y,
f
un
ct
io
nal
sta
tus
at
enr
ol
m
ent,
CD4
cel
l
cou
nt
le
ss
tha
n
50,
WH
O
cl
i
nical
sta
ge
IV
and
e
nrolm
ent
sta
tu
s
(b
ei
ng
on
pr
e
-
ART
or
on
A
RT)
rem
ai
ned
sta
ti
sti
cally
sig
nificant
pr
e
dictors
of
TB
Oc
currence
.
Acc
ordi
ng
ly
,
pe
ople
li
vin
g
with
H
IV
who
wer
e
am
bu
la
to
ry
or
be
dri
dde
n
at
enrollm
ent
wer
e
ab
out
3
tim
es
hig
her
ris
k
of
De
velo
ping
TB
at
any
ti
m
e
a
s
com
par
ed
to
those
who
w
ere
work
i
ng
(
AH
R=
2.89,
95%CI:
1.7
2
-
3.78
)
)
.
C
om
par
ed
with
patie
nts
ha
ving
te
rtia
ry
le
vel
of
e
ducat
ion
at
enrolm
ent,
patie
nts
with
no
ed
ucati
on
2.6
tim
es
te
nd
to
ha
ve
higher
incid
en
ce
of
TB
(
A
H
R=
2.6
8,
95%
CI:
1.4
1
-
5.1
1).
Th
os
e
w
ho
w
ere
at
WHO
c
li
ni
cal
sta
ge
I
V
ha
d
m
or
e
than
3
ti
m
es
higher
r
is
k
of
acq
uiri
ng
TB
at
any
ti
m
e
as
c
om
par
ed
t
o
th
os
e
wit
h
W
HO
cl
inica
l
sta
ge
I
or
II
(
A
HR=3.2
2,
95
%C
I:
1.9
1
-
5.41).
Sim
il
arl
y,
people
li
ving
with
HIV
th
os
e
w
ho
ha
d
pa
st
TB
histor
y
wer
e
about
1.65
ti
m
e
higher
ris
k
of
TB
ac
qu
isi
ti
on
as
c
om
par
ed
to
t
hose
w
ho
do
not
ha
d
(
AH
R=
1.65
,
95%CI:
1
.
06
-
2.39).
I
n
add
it
io
n,
pe
opl
e
li
vin
g
with
H
IV
w
ho
we
re
su
bs
ta
nce
us
e
at
enr
oll
m
ent
wer
e
1.4
6
tim
es
h
igh
e
r
risk
of
Dev
el
opin
g
TB
at
an
y
tim
e
a
s
co
m
par
e
d
to
th
os
e
who
we
re
no
t
add
ic
te
d
(AH
R=
1.46,
95%C
I:
1.03
-
2.06).
A
patie
nt
with
CD
4
cel
l
count
le
ss
tha
n
50
cel
l/
ul
wa
s
2.4
1
tim
es
m
or
e
li
kely
to
ha
ve
TB
at
any
tim
e
than
a
patie
nt
with
a
C
D
4
ce
ll
count
great
e
r
tha
n
250
cel
l/
ul
(
AH
R=
2.4
1(1.3
1
-
4.42).
Pati
ents
w
ho
wer
e
on
pr
e
ART
at
th
e
enrolm
ent
wer
e
1.6
2
ti
m
es
higher
risk
of
TB
acqu
isi
ti
on
as
com
par
ed
t
o
th
os
e
who
w
ere
on
ART
as
sho
wn in Ta
ble
4
.
4.
DISCU
SSI
ON
The
rece
nt
increase
in
w
or
ld
wide
prevale
nc
e
of
HIV
in
fe
ct
ion
has
co
ntr
ibu
te
d
to
the
r
isi
ng
gl
oba
l
incidenc
e
of
Tu
ber
c
ulo
sis
[
7].
I
n
Et
hiopi
a,
in
fecti
on
w
it
h
TB
is
a
m
ajor
public
he
al
th
pro
blem
with
a
n
est
i
m
at
ed
ann
ua
l
incidence
of
207
cases
per
100,000
popu
la
ti
on
s
for
al
l
form
s
of
TB.
HIV
-
posit
ive
pe
op
l
e
are
26
ti
m
es
at
higher
risk
t
o
dev
el
op
TB
co
m
par
ed
to
H
I
V
-
ne
gative
pe
op
le
i
n
co
untri
es
w
it
h
a
gene
rali
zed
HIV e
pid
em
ic
[
6]
.
It is als
o
th
e m
os
t com
m
o
n
ca
us
e
of d
eat
h
am
on
g pe
ople
li
vin
g wit
h
H
IV
[
3]
.
In
this
stu
dy
of
HIV
-
i
nf
ect
e
d
ad
ults
who
wer
e
in
HIV
chro
nic
care
in
public
healt
h
facil
it
y
of
H
awas
sa,
we
f
ound
that
the
i
ncide
nce
of
T
B
was
sig
nific
antly
hig
he
r
(8.79/1
00PY).
P
at
ie
nts
within
t
he
fir
st
ye
ar
fo
ll
ow
i
ng
ART
init
ia
ti
on
ha
d
a
te
m
porar
y
inc
rease
d
risk.
Illi
te
racy,
Past
TB
hist
or
y,
l
ow
e
r
CD
4
cel
l
count,
ad
va
nce
d
WH
O
sta
ge
IV
a
nd
e
nrolm
ent
sta
tus
(b
ei
ng
on
pre
ART
)
wer
e
ass
ociat
ed
with
a
hi
gh
e
r
risk
of
dev
el
op
i
ng
act
ive
TB.
Ac
cordin
gly,
the
ov
e
rall
incide
nc
e
of
TB
was
8.79
per
100
Pers
on
-
Ye
ars
.
It
was
si
m
il
ar
with
st
ud
y
co
nducte
d
in
Go
nde
r
[9]
,
Ethiop
ia
(
7.8
8
per
100PY)
because
they
us
e
the
sa
m
e
pr
oto
c
ol
with
our
st
ud
y
area
a
nd
ha
ve
t
he
sam
e
so
ci
o
-
econom
ic
chara
ct
erist
ic
s.
But
our
fin
ding
w
as
highe
r
f
r
om
stud
y
cond
ucted
i
n
Nige
ria
(2.58/
100PY)
an
d
Mozam
biq
ue
(
2.32
/
100PY
).
This
is
beca
use
of
m
et
ho
dolo
gical
diff
e
re
nce;
they
exclud
e
d
pat
ie
nts
on
pre
A
RT
and
the
firs
t
three
m
on
ths
after
init
ia
ti
on
of
ART
to
m
ini
m
iz
e
the
ef
fect
of
I
RIS.
A
naly
sis
that
inclu
des
pre
ART
a
nd
th
e
first
3
m
on
t
hs
after
init
ia
ti
on
of
ART
re
po
rted
t
he
highest TB
i
nc
idence
,
as i
n o
ur case
[10]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
6
, No
.
3
,
Septem
ber
201
7
:
26
6
–
27
4
272
The
hi
gh
e
st
in
ci
den
ce
rate
of
TB
was
obser
ved
i
n
the
fir
st
ye
ar
of
e
nrolm
ent.
TB
incide
nce
m
ay
rise
durin
g
t
he
init
ia
l
m
on
ths
on
ART
(as
in
our
case
),
w
hich
is
la
r
gely
du
e
to
ART
-
i
nduce
d
un
m
askin
g
of
su
bc
li
nical
act
i
ve
TB
and
delay
ed
diag
nose
d
of
unsp
eci
fic
sy
m
pto
m
at
ic
patie
nts
in
res
o
ur
ce
-
lim
it
ed
se
tt
ing
s
.
Howe
ver, TB incide
nce d
ecl
i
ned
with dur
at
i
on
inc
rem
ent o
n
ART, whic
h
li
kely
r
eflect
s t
he
co
ncurr
e
nt CD4
+
cel
l
cou
nt
incr
ease
and
im
mu
ne
rec
onsti
tuti
on
due
to
A
RT.
Be
cause
ART
suppress
es
viral
act
ivity
an
d
prom
otes
the
r
est
or
at
io
n
of
t
he
i
m
m
un
e
syst
e
m
,
hen
ce
le
a
di
ng
t
o
a
re
duce
d
ris
k
of
re
-
act
ivati
ng
la
te
nt
TB
or
of
em
e
rg
in
g
oppo
rtu
nisti
c
infecti
on
s
[
10
]
-
[
18
]
.
The
res
ult
al
so
s
howe
d
t
hat
al
m
os
t
al
l
of
patie
nts
were
sta
rted
ART
with
i
n
t
he
first
ye
ar
of
f
ollow
up
w
hi
ch
is
res
pons
i
bl
e
fo
r
IRIS.
T
he
othe
r
reas
on
m
igh
t
be
ab
out
41.
7
% of st
ud
y
par
t
ic
ipant e
nrolle
d
to
HIV
c
hroni
c care se
rv
ic
e
at
their a
dv
a
nc
ed WH
O
cl
inic
al
stage (II
I &I
V)
.
Table
4
.
M
ulti
ple Co
x
R
e
gr
e
ssion A
naly
sis
of Pr
e
dicto
rs o
f
T
ub
e
rc
ulo
sis
a
m
on
g PL
HIV
Co
horts
on Ch
roni
c
HIV Care
at
He
al
th Facil
it
y Fo
und i
n Ha
wassa
v
ariables
Su
rviv
al statu
s
CHR
(95
%C
I)
AHR(9
5
%C
I)
Level o
f
edu
catio
n
No
edu
c.
1
.34
(0.9
9
-
1
.80
)
2
.68
(1.4
1
-
5
.11
)
Pri
m
a
r
y
1
.12
(0.8
8
-
1
.45
)
1
.19
(0.6
5
-
2
.16
)
Seco
n
d
ary
1
.05
(0.5
0
-
1
.21
)
1
.5(0
.81
-
2
.78
)
Ter
tia
ry
1
1
Su
b
stan
ce us
e
Used
*
1
.56
(1.1
4
,2.1
2
)
1
.46
(1.0
3
-
2
.06
)
No
t us
ed
1
1
Past TB his
to
r
y
Yes
2
.45
(1.3
2
,4.5
3
)
1
.65
(1.0
6
-
2
.39
)
No
/n
o
t r
ecord
ed
1
1
Fu
n
ctio
n
al statu
s
W
o
rkin
g
1
1
A
m
b
u
lato
ry
/Bed
ri
d
d
en
3
.91
(2.8
6
,5.3
4
)
2
.89
(1.7
2
-
3
.78
)
W
HO
clinical
st
ag
e
I
/I
I
1
1
III
1
.30
(1.3
3
,2.6
6
)
1
.17
(0.7
9
,1.7
5
)
IV
6
.26
(4.1
0
,9.5
7
)
3
.22
(1.9
1
-
5
.41
)
CD4
cou
n
t
<5
0
3
.05
(1.7
8
,5.3
3
)
2
.41
(1.3
1
-
4
.42
)
51
-
250
1
.87
(1.2
9
,2.6
9
)
1
.23
(0.8
2
,1.8
5
)
≥2
5
1
1
1
Enro
l
m
en
t statu
s
Pre
AR
T
1
.51
(0.9
9
-
2
.30
)
1
.62
(1.0
3
-
2
.54
)
ART
1
1
*
Su
b
stan
ce us
ed
m
e
an
s th
o
se wh
o
us
ed
at
least o
n
e of
th
e f
o
llo
win
g
alco
h
o
l,
to
b
acco o
r
d
rug
s
In
th
e
analy
sis,
pr
e
dictor
s
that
wer
e
si
gn
ific
a
ntly
associat
ed
with
inc
reased
risk
of
TB
we
re
past
TB
histor
y,
ad
dicti
on,
am
bu
la
tory
or
bedrid
de
n
f
un
ct
io
nal
sta
tu
s
WHO
cl
inica
l
sta
ge
IV
an
d
low
C
D
4
cel
l
c
ount
at
baseli
ne.
Al
l
these
pr
e
dictors
had
al
ready
b
een
ide
ntifie
d
in
pre
vious
stud
ie
s
[
13
]
-
[
15
]
,
[
18
]
-
[
23]
.
In
this
stud
y
we
f
ound
t
hat
the
T
B
incidence
was
higher
i
n
patie
nts
with
a
m
bu
la
tory
or
be
dr
i
dd
e
n
ba
sel
ine
functi
onal
sta
tus
as
com
par
e
d
to
w
orki
ng
f
un
ct
io
nal
sta
tu
s.
This
is
in
li
ne
with
st
ud
y
cond
ucted
in
Gon
der
(AHR=1
.64,
95%CI:
1.13
-
2.
38).
T
his
c
ou
l
d
be
due
t
o
t
he
fact
that
pa
ti
ents
becam
e
bed
re
dd
e
ne
d
or
a
m
bu
la
tory
as
resu
lt
of
aff
ect
ed
by
m
any
infecti
ou
s
disease
s
wh
e
n
their
CD4
cel
l
count
is
low
an
d
as
a
resu
l
t
i
m
m
un
it
y becam
e com
pr
om
is
ed
the
p
at
ie
nts
wer
e
eli
gib
le
OI
s
inclu
din
g TB
[9]
.
Illi
te
racy
fr
om
the
so
ci
o
-
dem
ogra
ph
ic
facto
r
s
rem
a
ined
in
the
final
m
od
el
,
by
pr
e
dicti
ng
the
risk
of
dev
el
op
i
ng
TB
.
This
fin
ding
was
in
li
ne
with
stud
y
co
nducted
in
Brazi
l
(A
HR=
1.9
5,
95%CI:
1.2
9
–
2.9
4)
.
Poverty
a
nd
il
li
te
racy
wer
e
cl
os
el
y
associa
te
d;
as
a
res
ul
t
tho
se
who
w
ere
il
li
te
rate
w
ere
e
xp
ect
e
d
t
o
li
ve
unhygie
nic
co
nd
it
io
n,
unbal
anced
nutrit
io
n
a
nd
la
c
k
of
inf
or
m
at
ion
or
awar
e
ness
(
14,
24).
WH
O
cl
inica
l
sta
ge
I
V
ha
d
3
tim
es
(A
HR=2.93,
95%CI=
1.72
-
4.98)
hi
gher
risk
of
TB
incidenc
e
tha
n
W
H
O
cl
inica
l
sta
ge
I
or
II
,
t
his
is
in
li
ne
with
st
udy
done
in
G
onde
r
(
A
HR=3.82,
95%CI:
1.86
-
7.85))
at
D
are
S
al
am
,
Ta
nzan
ia
3.44(
3.06
–
3.87)
[
18
]
.
A
no
t
her
pros
pecti
ve
st
ud
y
resu
lt
s
whic
h
was
al
s
o
c
o
nducted
in
Ta
nz
ania
sho
ws
si
m
il
ar
(AHR=2
.48,
95%CI:
1
.
88
–
3.26)
t
her
e
we
re ma
ny
stud
ie
s
w
hic
h
was
c
on
current w
it
h
ou
r
stu
dy [
9
]
-
[
11
]
,
[
15
]
-
[18]
.
Eve
n
t
ho
ugh, TB ca
n oc
cur at
an
y
WH
O
cl
inica
l st
ag
e it
is m
or
e co
m
m
on
in
a
dva
nced cl
inica
l st
age
[8
]
.
Ba
sel
ine
C
D4
cel
l
cou
nt
of
<
50
cel
ls/
µl
was
a
ver
y
str
ong
an
d
in
dep
e
ndent
ris
k
fact
or
associat
e
d
with
a
h
ig
her
r
isk
of
TB
in
pa
ti
ents
enr
olle
d
to
chro
nic
H
IV
care
(
A
HR
=2.41
,
95
%
C
I=1.3
1
-
4.4
2).
I
n
fact,
the
highest
TB
incidence
(16.74
/
100PY)
in
this
coho
rt
ana
ly
si
s
was
ob
se
rv
e
d
am
on
g
pa
ti
ents
with
bas
el
ine
CD4
c
ount
<
50
cel
ls/
µl
.
L
ow
er
ba
sel
ine
CD
4
c
ount
be
f
or
e
ini
ti
at
ion
of
A
RT
has
c
onsist
ently
been
in
dicat
ed
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N:
22
52
-
8806
In
ci
den
ce
an
d Predict
or
s
o
f
T
ub
e
rcul
os
is
among Ad
ult P
L
WHA at P
ubli
c H
e
alth
.... (H
eno
k
Bekel
e)
273
as
an
i
nd
e
pe
ndent
ris
k
fact
or
for
occurre
nce
of
Tu
be
rcu
l
osi
s
durin
g
t
he
c
ourse
of
H
IV
treat
m
ent
a
nd
c
are
i
n
diff
e
re
nt
set
ti
ng
s
[
9
]
,
[
13
]
,
[
18
]
,
[
22
].
A
stu
dy
in
W
est
Afr
ic
a
has
ind
ic
at
e
d
that
baseli
ne
CD4
c
ount
has
no
a
ny
associat
ion
with
the
oc
cu
rr
e
nc
e
of
TB
durin
g
H
AA
RT
[
24
]
-
[
25
]
.
This
wa
s
because
the
s
tud
y
ha
d
li
m
itati
o
ns
in
de
sig
n
r
el
at
ed
to
siz
e
of
th
e
stu
dy
po
pu
la
ti
on
,
t
he
num
ber
of
TB
cases
,
diag
nosti
c
crit
eria
f
or
tu
ber
c
ulo
sis
and rest
rict
ed
c
ohort
co
m
po
sit
ion
.
Accor
ding
to
our
res
ults,
hi
gh
ris
k
be
ha
viors
li
ke
substa
nc
e
us
e;
to
al
co
ho
l,
t
ob
acc
o
or
drugs
we
re
1.46
ti
m
es
hig
her
ris
k
of
devel
op
in
g
TB
tha
n
no
t
us
ed
.
Th
ese
al
so
identif
ie
d
as
risk
factor
s
am
on
g
no
n
HIV
po
sit
ive
pe
opl
es.
These
hi
gh
risk
beh
a
vi
ors
m
igh
t
pr
edis
po
s
e
HIV
pa
ti
ents
to
TB
infecti
on
facto
rs
[
21
]
.
Accor
ding
to
our
resu
lt
s,
pa
st
TB
histo
ry
of
i
nf
ect
io
n
w
as
ide
ntifie
d
a
s
risk
fact
or
s
.
This
m
igh
t
be
because
act
ivati
on
of
l
at
ent
TB
on
pe
op
le
who
were
i
m
m
un
e
co
m
pr
omi
sed
as
a
resu
lt
of
HIV
in
fecti
on
t
ha
n
th
os
e
who did
n
ot
ha
d hist
or
y
of TB
inf
ect
io
n [
14
]
,
[
21
]
.
Since
it
was
ba
sed
on
seco
ndary
data
so
m
e
of
t
he
im
po
r
ta
nt
pr
e
dicat
or
s
w
hich
had
a
si
gn
i
ficant
associat
ion
w
it
h
TB
occ
urre
nc
e
with
ot
her
s
tud
ie
s
li
ke
bo
dy
m
ass
ind
ex
wer
e n
ot
incl
uded
i
n
the
a
naly
sis
du
e
to
inc
om
plete
reg
ist
rati
on
of
heig
ht
in
al
m
os
t
half
of
th
e
c
har
ts
a
nd
as
w
el
l
as
Heam
og
lob
i
n
le
vel.
It
is
al
so
diff
ic
ult
to
know
the
e
xa
ct
date
of
tu
ber
c
ulo
sis
occ
urre
nce
as
it
is
a
chro
n
ic
diseas
e
and
not
rec
orde
d
the
exact date
of
diagnosis
w
hich m
ay
o
ver
-
est
im
at
e the m
edia
n
ti
m
e o
f
tu
berculosis.
Mi
ssin
g
is a
nother
concer
n.
5.
CONCL
US
I
O
N
The
bu
rd
e
n
of
TB
a
m
on
g
pr
e
ART
en
ro
ll
ee
s
was
sig
nifica
nt.
Most
of
the
cases
(TB)
we
re
occ
urre
d
in
the
fir
st
ye
ar
of
en
r
olm
e
nt
to
ch
r
on
ic
HIV
care
.
A
dvance
d
WHO
cl
inica
l
sta
ge
(sta
ge
I
V),
lim
it
ed
functi
onal
sta
tus,
past
TB
histor
y,
substanc
e
us
e
,
bein
g
on
pr
e
ART
a
nd
lo
w
CD
4
(<
50
cel
l/
ul)
co
unt
at
enroll
m
ent
wer
e
fo
un
d
to
be
the
ind
e
pe
nd
e
nt
pr
edict
or
of
tu
ber
c
ulo
sis
occ
urren
ce
.
Stre
ngthen
the
im
po
r
ta
nce
of
TB
scree
ni
ng
a
nd
ea
rly
i
niti
at
ion
of
A
RT
is
ver
y
i
m
portant
to
lim
i
t
the
tim
e
sp
ent
at
low
le
vel
of
CD
4
count
reg
a
rd
le
s
s their C
D
4
c
ount a
nd
WHO
cl
inica
l.
ABBREV
IAT
ION
S
AHR:
A
dju
ste
d
hazar
d
rati
o
,
A
RT
:
A
nti
-
re
tro
viral
the
ra
py
,
H
AART
:
hi
gh
ly
act
ive
a
ntiret
roviral
th
erap
y,
IDR
:
i
ncide
nc
e
de
ns
it
y
rate,
OI
:
oppo
rtu
ni
sti
c
infecti
on
,
PLWH
A
:
pe
op
le
li
vi
ng
wi
th
H
IV
/
AIDS,
TB
:
Tu
ber
c
ulo
sis,
VCT
:
vo
l
unta
r
y counseli
ng a
nd test
ing,
W
HO
: w
orl
d hea
lt
h
orga
nizat
io
n
.
ACKN
OWLE
DGE
MENT
The
auth
ors
w
ou
l
d
li
ke
to
thank
the
Ha
wa
ssa
ci
ty
adm
inist
rati
on
healt
h
dep
artm
ent
for
fina
ncial
su
pp
or
t t
hat
m
ade th
is
stud
y po
s
sible. They
would
al
so
li
ke
to
thank
the dat
a colle
ct
or
s f
or
their tolera
nc
e an
d
colla
borati
on
duri
ng the
data
colle
ct
ion
.
REFERE
NCE
S
[1]
M.
Jon F.
,
“
Tub
erc
ulosis
,”
i
n
Jo
nat
han
C
.
and
W
il
liam
P. eds.
,
“
Infe
ctious Disea
s
es
,”
v
o
l. 1, Spain
,
Mos
b
y
,
2004
.
[2]
Rei
d
A
.
,
et
a
l.
,
“
Towa
rds
unive
rsal
acce
ss
to
HIV
pre
ve
nti
on,
treatment
,
c
are,
and
support:
th
e
rol
e
of
tube
rcu
losis/HIV c
ollabora
t
ion
,”
Lance
t
In
fe
c
t D
is.
,
vol
.
6
,
pp
.
483
-
95
,
2006
.
[3]
W
HO
,
“
Priority
rese
arc
h
quest
io
ns for
TB/
HIV
i
n
HIV
-
pre
valen
t
and
r
esourc
e
-
lim
it
ed
set
ti
ngs
,”
vol.
3
,
2010
.
[4]
MO
H,
“
Nati
onal c
om
pre
hensiv
e HIV
ca
re
and
treatment
tra
in
ing m
anua
l
for
healt
h
provide
rs,
”
Ethiopia
,
2014
.
[5]
Marc
o
V
.
,
et
al
.
,
“
The
Global
Fight
aga
inst
HIV
/AIDS
,
Tube
rcu
losis,
and
Mala
ri
a.
Curre
nt
St
at
us
and
Future
Perspec
ti
v
es
,”
A
meric
an
Soc
iety for Cl
inical
Pat
h
ology
,
pp.
1
-
4
,
2
009
.
[6]
W
HO
,
“
Global
Tube
rcu
losis Report
of
2015
,”
G
ene
va
,
Sw
itzer
l
a
nd
,
W
orld
He
alt
h
Organi
z
at
io
n,
2015.
[7]
Bank
W
.
,
“
Disea
se
and
Mort
alit
y
in
Sub
-
Sahar
an
Afric
a
,”
Se
cond .e
d.
W
ashingt
on
,
2006.
[8]
Fauci
A
.
S
.
,
e
t
a
l.
,
“
Harri
son’s
Princi
pl
es
of
In
te
r
nal
Medi
ci
n
e
(1
6th
Edition)
,”
M
cGra
w
-
Hill
,
Ne
w York
,
pp.
107
6
-
139
,
2005
.
[9]
Kef
y
al
ew
A
.
,
et
al.
,
“
Inc
id
ence
and
pre
dictors
of
tube
rcu
losis
among
adul
t
pe
ople
li
v
ing
with
hum
an
imm
un
e
def
iciency
v
irus
at
the
Univ
ersity
o
f
Gondar
Referral
Hos
pit
al,
No
rthwe
st
Et
hiop
ia
,”
BMC
Inf
ectio
us
Diseases
,
vol.
13
,
pp
.
292
,
201
3
.
[10]
Auld
A
.
F
.
,
et
a
l.
,
“
Inc
ide
n
ce
an
d
Dete
rm
ina
nts
of
Tube
r
cul
osis
among
Adults
Init
iating
Ant
ire
t
rovira
l
The
r
ap
y
–
Moza
m
bique
,
20
04
–
2008
,”
PLoS
ONE
,
vol/is
sue:
8(1)
,
pp.
e5466
5
,
2008
.
[11]
Chang
C
.
A
.
,
et
al
.
,
“
Tub
erc
u
lo
sis
inc
ide
n
ce
an
d
risk
fac
tors
a
m
ong
HIV
-
infe
ct
ed
adu
lt
s
re
ce
iv
ing
ant
i
ret
rov
iral
the
rap
y
in
a
l
arg
e
HIV
progra
m
–
Niger
ia
,
2004
–
2012
,”
Open
forum
Infe
ct
ious
Diseases
Adv
ance
Acce
ss
soci
ety
of
Ame
ri
ca
,
pp.
1
-
40
,
2015.
[12]
Brinkhof
M
.
,
e
t
al.
,
“
Tube
r
culos
is
aft
er
ini
t
iation
of
ant
ir
et
r
ovira
l
th
era
p
y
i
n
low
-
inc
om
e
and
high
-
inc
om
e
count
ri
es
,”
Cli
n
nfe
c
t
Dis
.
,
vol
/i
s
sue:
45(1518
-
21
)
,
2007
.
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
6
, No
.
3
,
Septem
ber
201
7
:
26
6
–
27
4
274
[13]
Abate
A
.
,
e
t
al.
,
“
The
eff
ec
t
of
i
nci
den
t
tube
rc
ul
osis
on
im
m
unol
ogic
a
l
response
of
HIV
pat
ie
nts
on
highly
ac
t
iv
e
ant
i
-
r
et
rovir
al
th
era
p
y
a
t
the
uni
ver
sit
y
of
Gondar
hospita
l
,
nort
hwest
Et
hiopia:
a
ret
rospe
ct
iv
e
f
oll
ow
-
up
stud
y
,”
BMC
Inf
ec
t
ious
Diseases
,
vol
.
14
,
pp
.
468
,
2014
.
[14]
Bat
ista
J
.
D
.
L
.
,
et
al
.
,
“
Inc
id
ence
and
Risk
Factors
for
Tube
rcu
l
osis
in
People
L
ivi
ng
with
HIV
:
Cohort
from
HI
V
Refe
rra
l
He
al
th
Cent
ers in R
ec
if
e,
Br
azil
,”
PLoS
ONE
,
vol
/i
ss
ue:
8(5)
,
pp
.
e63916
,
2013
.
[15]
Naka
nja
ko
D
.
,
et
al
.
,
“
Tube
rcu
losis
and
hum
an
imm
unodef
ic
ienc
y
virus
co
-
inf
ec
t
ions
and
the
i
r
pre
di
ct
ors
a
t
a
hospita
l
-
b
ase
d
H
IV/AID
S c
li
nic i
n
Uganda
,”
Int J
Tuberc
Lung Di
s
.
,
vol
/i
ss
ue:
14(
12)
,
pp
.
1621
-
8
,
2010.
[16]
As
sefa
D
.
,
et
al
.
,
“
Inte
nsifi
ed
t
uber
cul
osis
ca
s
e
fi
nding
am
ong
peopl
e
li
vi
ng
with
the
h
um
an
im
m
unodef
i
ci
en
c
y
virus
in
a
hospit
al
cl
in
ic
in
Et
h
iopi
a
,”
The
Inte
rnat
io
nal
Journal
o
f
Tuberculosis
and
Lung
Disease
,
vol/
issue:
15(3)
,
pp.
411
-
3
,
2011
.
[17]
Hara
ka
F
.
,
et
al
.
,
“
A
Bundle
of
Services
Inc
r
ea
se
d
As
ce
rtainm
ent
of
Tub
erc
u
losis
among
HIV
-
Infe
cted
Indiv
idual
s
E
nrolled
in
a
HI
V Cohort
in
Rur
al
Sub
-
Sahar
an Africa
,”
PLoS
O
NE
,
vo
l/
issue:
1
0(4)
,
pp
.
e01232
75
,
20
15
.
[18]
Li
u
E
.
,
et
al
.
,
“
T
uber
cul
osis
in
cidenc
e
r
ate
and
ri
sk
fac
tors
among
HIV
-
infe
ct
ed
adul
ts
with
ac
c
e
ss
to
ant
iretrovir
al
the
rap
y
–
Ta
nz
a
nia
,
2004
-
2012
,”
HHS
Publ
i
c
,
pp.
1391
–
1399
,
20
15
.
[19]
Moham
ed
T
.,
et
al
.,
“R
isk
fac
to
rs
of
ac
t
ive
TB
in
PLW
HA
sout
hwest
Et
hiop
ia
,”
Et
hiop
J
hea
lt
h
Sci
.
,
vol
/i
ss
ue
:
2(21)
,
pp
.
131
-
1
39
,
2011
.
[20]
A.
D.
Kerkhoff,
et
al
.
,
“
The
pr
edi
c
ti
ve
va
lue
o
f
cur
ren
t
Hea
m
oglobi
n
le
v
el
s
for
inc
ide
n
t
tubercul
osis
and/
or
m
orta
li
t
y
during
long
-
te
rm
ant
ir
e
trovi
ra
l
the
rap
y
i
n
South
Afric
a:
a
cohor
t
stud
y
,”
BMC
Me
d
.
,
vol/
i
ss
ue:
13(1)
,
p
p.
70
,
2015
.
[21]
Dam
al
ie
N
.
,
et
a
l
.
,
“
TB/
HIV
co
-
i
nfe
ction
and
t
her
e
pre
dictors a
t
hospita
l
base
d
HIV
/AIDS
cl
ini
c
in
Uganda
,
”
pp.
6
-
7,
2009
.
[22]
Kibre
t
K
.
T
.
,
et
al.
,
“
Dete
rm
ina
n
t
Fact
ors
As
soci
at
ed
wi
th
Oc
cur
r
enc
e
of
Tub
erc
u
losis
among
Adult
Peopl
e
L
ivi
n
g
with
HIV
aft
er
Antire
trov
ira
l
Tr
ea
tment
Ini
ti
a
ti
o
n
in
Addis
Abab
a,
Et
h
iopi
a
:
A
Case
Control
Stud
y
,”
PLoS
ONE
,
vol/
issue:
8(5)
,
p
p.
e64488
,
2013
.
[23]
Bonnet
M
.
,
e
t
a
l.
,
“
Tube
rcu
losis
after
HA
ART
ini
t
ia
t
ion
in
HIV
-
positi
ve
p
at
i
ent
s
from
five
count
ri
es
with
a
high
tub
erc
ulosi
s burde
n
,
”
vol
/i
s
sue:
20(9)
,
pp
.
1
275
-
79
,
2006
.
[24]
Gupta
R
.
and
Ku
m
ar
P.
,
“
Soci
al
e
vil
s,
pov
erty
and
he
alth
,”
Indian
J
Me
d
R
es
.
,
vol
.
126
,
pp
.
279
–
28
8
,
2007
.
[25]
Se
y
l
er
C
.
,
e
t
al.
,
“
Risk
fac
tors
for
ac
ti
v
e
tube
rc
ulosis
aft
er
ant
i
r
et
rovir
al
treatme
nt
ini
tiati
on
in
Abidja
n
,
”
Am
J
Re
spir Crit
Care
Me
d
,
vol
.
172
,
p
p.
123
–
127
,
200
5
.
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