Analysis of Factors Associated with Death Among TB/HIV Infected Persons at Masvingo Provincial Hospital, Zimbabwe, 2022- 2024

Abstract

HIV pandemic presents a significant challenge to global tuberculosis (TB) control. TB and HIV work in synergy potentiate the effect of the other. Among people living with HIV, TB is the most common cause of death. TB/HIV coinfection is still a notable public health challenge, particularly in resource-limited settings like Zimbabwe. In 2019 TB accounted for 30% of HIV related deaths. Zimbabwe has transitioned out of the 30 high TB Burdened countries but it remains in the 30 high TB/HIV and MDR or rifampicin resistant TB burdened countries. The study aimed at analyzing the prevalence of death outcome, the clinical and demographic characteristic of those who died and factors that are associated with mortality among this subgroup. This was a hospital based retrospective cohort study of HIV positive patients receiving anti-TB treatment in at Masvingo provincial hospital, Zimbabwe from 2022 to 2024. Secondary data analysis was done on all HIV positive persons who received TB treatment in the TB/OI clinic. A total of 207 people met the eligibility criteria. The outcomes were death, cured and completed treatment. The variables that were looked at include sex, age, ART status, referral type, comorbidities and residence. The mortality rate among TB/HIV persons was 17.9% while 67.6% completed treatment and 14.5% were cured. Around 70.3% of deaths happened within the first month. The average age of death was 47.0±24.5 years. The majority 30/37 (81.0%) were male and they resided in the urban area. About sixty two percent (62.2%) were not on ART. Of those who died, 90.0% had pulmonary TB. Sputum analysis was not done on 20.3% of the patients while 6.8% had rifampicin resistant TB. The majority of deaths were those who were referred from the wards. Gender was found to be a significant predictor of death with males having the higher odds of mortality compared to females with a p =0.016 and a coefficient of 1.1. Age was also a significant factor associated with death with a p value of 0.037 and a coefficient of 0.2 meaning that as age increases the likelihood of death increases. The Pearson Chi-Square result, indicated that sex significantly influences the likelihood of cure, death, or completion of treatment with a p value of 0.021. In this study ART status and being diabetic did not show any statistical significance. ART usage remains a key factor in reducing the risk of death. In this study even those who were 2 weeks on ART were classified as being on ART, this factor could have affected the effect of being on ART and late diagnosis on mortality. There is need to strengthen early HIV diagnosis and screening of opportunistic infections prior to starting ART. Gender oriented initiatives that aim at improving the health seeking behavior of men need to be strengthened. There is need to address hospital based resource constraints and enhancing diagnostic infrastructure.