WOLAITA SODO UNIVERSITY

COLLEGE OF HEALTH SCIENCE AND MEDICINE

SCHOOL OF PHARMACY

ASSESSMENT OF PREVALENCE ANDFACTORS AFFECTING THE

DEVELOPMENT OF ACTIVE-TB INFECTION AMONG HIV/AIDS PATIENTS IN
ART CLINIC AT WOLAITA SODO UNIVERSTY COMPREHENSIVE SPECILIZED
HOSPITAL, SOUTHERN ETHIOPIA,2022

A RESEARCH PROPOSALTO BE SUBMITTED TO SCHOOL OF PHARMACY,

COLLEGE OFMEDICINE AND HEALTH SCIENCE, WOLAITA SODO UNIVERSTY.

BY:-

MEKDELAWIT GIZAW …….027/11

BIRTUKAN ABEBE ………058/10

MELKAMU TEKALEGN ….034/10

FIRAOL MEKONNEN……158/10

BEREKET MATIWOS…….090/10

Under the supervision of

Mr Amsalu Gulla(MSc. Pharmaceutics)

Sep, 2022

Wolaita Sodo, Ethiopa

 ACKNOWLEDGEMENT

We would like to thanks School of Pharmacy College of Health science and Medicine for
providing such a chance of study and offering technical support and assigning advisor timely.
We would also like to express our gratitude to our advisor MR Amsalu Gulla for his desirable
effort in giving us a guidance, comments, suggestion and correction on our proposal. Our
gratitude also goes to all the people helped us in the preparation of this proposal.

i
 TABLE OF CONTENTS

ACKNOWLEDGEMENT................................................................................................................i
List of Tables..................................................................................................................................iv
Acronyms & Abbreviations.............................................................................................................v
SUMMARY....................................................................................................................................vi
Introduction:................................................................................................................................vi
Objective:....................................................................................................................................vi
Methodology:..............................................................................................................................vi
CHAPTER ONE: INTRODUCTION..............................................................................................1
1.1 General Background..............................................................................................................1
1.2 Statement of the problem.......................................................................................................2
1.3 Significance of the study........................................................................................................3
CHAPTER TWO: LITERATURE REVIEW..................................................................................4
2.1 Prevalence of active tuberculosis among ART patients.........................................................4
2.2 Factors affecting the development of active TB on ART patients.........................................5
CHAPTER THREE: OBJECTIVE..................................................................................................8
3.1General Objective:..................................................................................................................8
3.2 Specific objective:..................................................................................................................8
CHAPTER FOUR: METHODOLOGY..........................................................................................9
4.1. Study setting and study period..............................................................................................9
4.2 Study design...........................................................................................................................9
4.3 Population..............................................................................................................................9
4.3.1 Source population............................................................................................................9
4.3.2 Study population..............................................................................................................9
4.4 Inclusion and exclusion criteria.............................................................................................9
4.4.1 Inclusion criteria..............................................................................................................9
4.4.2 Exclusion criteria.............................................................................................................9
4.5 Sample size determination and Sampling technique............................................................10
4.5.1 Sample size determination.............................................................................................10
4.5.2 Sampling technique.......................................................................................................10
4.6 Data Collection Method.......................................................................................................11

ii
 4.6.1 Data collecting instrument and procedure.....................................................................11
4.7 Study Variables....................................................................................................................11
4.7.1 Dependent Variables:....................................................................................................11
4.7.2 Independent Variables...................................................................................................11
4.8 Operational definitions.........................................................................................................11
4.9 Data quality control..............................................................................................................12
4.10 Data collection process& analysis.....................................................................................12
4.11 Dissemination of the results...............................................................................................12
CHAPTER FIVE: WORK PLAN.................................................................................................13
CHAPTER SIX: BUDGET...........................................................................................................14
6.1 Detail Budget.......................................................................................................................14
REFERENCE................................................................................................................................15
ANNEX.........................................................................................................................................18

iii
List of Tables

Table 1:Work plan of assessment of prevalence and factors affecting the development of active-
TB infection among HIV positive patient in ART clinic at
WSUCSH……………………………….14

Table 2:Budget required for assessment of prevalence and factors affecting the development of
active-TB infection among HIV positive patient in ART clinic at WSUCSH…………………….
………15

iv
Acronyms & Abbreviations

AFB……………. Acid Fast Bacilli

AIDS…………… Acquired Immune Deficiency Syndrome

ART……………. Anti -Retroviral Therapy

EPTB…………… Extra Pulmonary Tuberculosis

FMOH…………. Federal minister of Health

HAART…………. Highly active anti- retroviral therapy

HIV………………Human Immunodeficiency virus

WSUCSH………. Wolaita Sodo university comprehensive specialized hospital

MTB……………… Mycobacterium Tuberculosis

PLWHIV…………. People Living with Human Immune- deficiency Virus.

PTB………………. Pulmonary Tuberculosis

RVI………………. Retro viral Illness

TB………………… Tuberculosis

WHO………………World Health Organization

v
SUMMARY

Introduction: This research will determine the prevalence and factors affecting the
development of active TB among HIV patients will have a great importance for the healthcare
professional in Wolaita Sodo in making appropriate adjustments as a solution and in the local
context it is critical for our country to improve TB/HIV co-infected patients’ co-management.

Tuberculosis is the most common presenting opportunistic infection among HIV-infected

patients, who remain at high risk for TB throughout the course of their disease. Tuberculosis and
HIV have been closely linked since the emergence of AIDS. HIV infection has contributed to a
significant increase in the worldwide incidence of tuberculosis. Due to the shared immune
defense mechanisms between the two diseases, TB is a leading preventable cause of death
among people living with HIV.

Objective: The aim of this study will be conducted to assess the prevalence and factors
affecting the development of active-TB infection among HIV positive patients in ART clinic at
Wolaita Sodo university comprehensive specialized hospital

Methodology: Hospital based retrospective cross-sectional study design will be done on 327
patients April - Aug 2022 at Wolaita Sodo university comprehensive specialized hospital. Data
will be collected by using structured checklist which contains patient's socio-demographics
characteristics and clinical and laboratory profile. Simple random sampling technique will be
employed to enroll the aforementioned sample size during the study period. Quantitative data
will be completed and interpretation will be done according to the finding of the study data will
be presented in tables and figures.

Work Plan & Budget: Work plan of the study contains topic selection, reviewing different
literature, proposal writing, data collection, data analysis and research paper submission with
appropriate time for each activities. A total of 2137 birr is required for the study.

Key word: prevalence, factor

vi
 CHAPTER ONE: INTRODUCTION

1.1 General Background

HIV and TB are the first and second leading causes, respectively of death globally due to a
single infectious agent[1, 2]. Due to the shared immune defense mechanisms between the two
diseases, TB is a leading preventable cause of death among people living with HIV and vice
versa[1, 3].

Tuberculosis is the most common presenting opportunistic infection among HIV-infected

patients, who remain at high risk for TB throughout the course of their disease. TB and HIV have
been closely linked since the emergence of AIDS. HIV infection has contributed to a significant
increase in the worldwide incidence of tuberculosis. By producing a progressive decline in cell-
mediated immunity, HIV alters the pathogenesis of tuberculosis, greatly increasing the risk of
developing disease and leads to more frequent extra pulmonary (EPTB) involvement and
atypical radiographic manifestations[4].

TB/HIV co-infection causes a serious bidirectional and synergistic combination of illness in

which HIV promotes the progression of latent TB infection to disease, and TB accelerates the
progression of HIV disease to poor prognosis including death[5].

In healthy people, infection with MTB often causes no symptoms, since the person's immune
system acts to wall off the bacteria[1, 6].

It is among the leading causes of death for PLWHIV which shares about 25% of all causes of
deaths[7].

[24]
Around 14 million individuals worldwide are estimated to be co- infected . According to
World Health Organization report Ethiopia ranks 7 among the 22 high burden countries with TB
and HIV infection in the world. Likewise, TB has been reported to exacerbate HIV infectio n[4, 8,
9]
.

Most of these deaths occur in resource-limited settings like Ethiopia. TB and HIV/AIDS
constitute the main burden of infectious disease in resource-limited countries [10].

1
1.2 Statement of the problem
TB is an infectious disease and it is the most frequently diagnosed opportunistic infection and
disease in HIV infected patients world-wide[4, 11].

Despite being preventable, it is still a leading killer of people living with HIV. At least one in
four deaths among PLWHIV can be attributed to TB, and many of these deaths occur in
developing countries[3].

Worldwide about 11.1 million adults are co-infected with TB and HIV. Seventy percent of co-
infected people are living in sub-Saharan Africa. Tuberculosis becoming a major public Health
problem, especially in area where HIV infection rates is higher[12].

Globally, over one in ten of the 9 million people who develop TB each year are HIV-positive; Of
the 8.8 million incident cases of TB in 2010, 1.1 million (1.0 million– 1.2 million) were among
people living with HIV. The proportion of TB cases co infected with HIV is highest in countries
of the African region; overall, accounted for 82% of TB cases among people living with HIV.
Tuberculosis has been recognized as a major public health problem for more than five decades in
Ethiopia. According to the 2014 WHO TB report, the prevalence of all forms of TB, TB
mortality, and TB/HIV co-infected patients’ mortality were 211, 32 and 5.9 per 100,000
populations, respectively[9].

According to the 2010 World Health Organization HIV disease stages (WHO) report on TB
profiles for different countries, Ethiopia was classified as a high burden TB, a high burden HIV
but according to the new WHO update Ethiopia has released from the list burden Multi-drug
resistance TB (MDR-TB) nation [11].

In Ethiopia, TB/HIV co-infected patients had greater risk of common mental disorders, lower
quality of life, low family income and poor physical health than HIV infected patients without
active TB[13].

The management of TB and HIV co-infected individual is challenging because of: pill burden,
increase adverse effect, drug to drug interaction and immune reconstitution inflammatory
syndrome (IRIS)[14].

2
1.3 Significance of the study
Determining the prevalence and factors affecting the development of active TB among HIV
patients will have a great importance for the healthcare professional in Wolaita Sodo in making
appropriate adjustments as a solution and to improve TB/HIV co-infected patients’ co-
management.

The knowledge of the prevalence and factors affecting the development of active TB disease
among HIV infected population in a local context will also help to reduce the burden of the
disease by facilitating the early detection of at-risk patients and urging the responsible authority
for devising surveillance and proper follow-up activities in the area of TB/HIV collaborative.

It is anticipated that findings from this study will contribute to the body of knowledge that
informs TB/HIV program planners, decision makers, and project implementers by providing
factors affecting the development of active TB on ART population.

This study will be in view of the need to accelerate efforts and reach the international targets set
in the context of TB/HIV co-infection, the result of this study will also plays significant role by
increasing awareness toward early detection and prevention of the diseases.

Identifying the potential risk factors for development of TB on ART patients, may help the anti
TB treatment not to takes a long time unlike other OI’s treatment which create pill burden for
those who are on HAART.

Moreover, there are only few of studies done in the TB/HIV co-infection in the other area of
Ethiopia, which do not represent our study setting. Therefore, this study will help to design
regular surveillance techniques of TB infection in HIV patients. Thus, assisting physicians to
identifying factors affecting the development of the active - TB infection in HIV patients and
expect these infectious disease trends a head of time to manage them.

3
 CHAPTER TWO: LITERATURE REVIEW

2.1 Prevalence of active tuberculosis among ART patients

Tuberculosis (TB) remains one of the world’s deadliest communicable diseases. In 2020, an
estimated 10 million people (140/100,000) were ill of TB, and 1.3 million TB deaths occurred
among HIV- negative people. About 7.5% of all incident cases of TB worldwide occur among
people living with HIV(PLHIV), where AFRICA stands the highest[15].

In 2014, WHO estimates 9.6 million individuals who developed incident tuberculosis, of which,
1.3 million or 12%, were co-infected with HIV. Almost three-quarter of these cases were in the
African region[15].

In 2013, an estimated 9.0 mil-lion people developed TB and 1.5 million died from the disease.
An estimated 1.1 million (13%) of the 9 million people who developed TB in 2013 were HIV-
positive.

The prevalence of TB was estimated to be 394 per 100, 000 populations including those co-
infected with HIV and there were 152, 030 new cases of which 3,190 were below 15 years of
age[16].

It was estimated that 36.9 million people are living with HIV (PLHIV) in the world. In some part
of the world, the prevalence of PLHIV continues to increase as result of availability of anti-
retroviral drugs. The statistics showed that nearly 2 million people were newly infected with HIV
and 1.2 million people died due to AIDS-related diseases annually[10].

The African Region accounts for about four out of every five HIV-positive TB cases and TB
deaths among people who are HIV positive and the majority of victims live in sub Saharan
Africa, which accounts seventy percent (70%) [17]. Some Africa countries have reported
continuing rises in tuberculosis case rates despite declining HIV prevalence, while others show
stable or declining tuberculosis incidence among HIV-negative individuals[7].

The case fatality ratio (the global proportion of people with TB who die from the disease) varied
from under 5% in a few countries to more than 20% in most countries in the WHO African
Region. This shows considerable inequalities among countries in access to TB diagnosis and
treatment that need to be addressed[18].

4
According to Khazaei et al., (2016), the prevalence of TB patients was 21.9% among HIV
patients. About 57.4% of the patients were below 35 years of age and most of them (85.5%) were
male. The result of the study done in Tanzania showed that, from a total of 67,686 patients
assessed7,602 patients were diagnosed with active TB[6].

According to a study conducted in Ethiopia reported that a TB/HIV co-infection prevalence of 18

% ranging from 8.3 % (in Silte zone) to 35.3 % (in South Omo zone)[19].

Study from Hawassa University Referral Hospital, south of Ethiopia found that, from a total of
499 HIV/AIDS positive patients, ninety-one (18.2%) of the study participants were found to
have tuberculosis of which, 20 (22%), 58(64%) and 13 (14%) were smear positive, smear
negative and extra-pulmonary tuberculosis cases, respectively[14].

Tuberculosis threatens the poorest and most marginalized populations [30]. The current increasing
HIV associated tuberculosis shifted the clinical pattern TB towards smears negative pulmonary
PTB and extra pulmonary TB EPTB(9, 20). The prevalence of TB among HIV positive clients in
Ethiopia was 7.8%[1, 9-11, 21].

From a total of 571 HIV positive study participants enrolled, 158 (27.7%) were found to have
pulmonary tuberculosis[22].

Another study done in Dilla Hospital, south of Ethiopia explored that, from 1391 ART patients,
178 (12.8%) had active TB, of which 143(80.3%) patients with pulmonary TB and 19.7% with
extra pulmonary TB [23].

2.2 Factors affecting the development of active TB on ART patients

A cross-sectional study conducted in Abadan and Khorramshahr, the south west of Iran on a total
of 366 HIV/AIDS positive patients with medical records found that co-infection with hepatitis B
and drug abuse can dramatically increases the risk of TB in HIV/AIDS patients. This study also
reveals that male gender, history of imprisonment, co-morbidity with hepatitis C, stage of
disease, and CD4 cell count were statistically significant and associated with the incident of
TB[24].

5
The cross-sectional record review on 1320 HIV/AIDS patients in Aminu Kano Teaching
Hospital, Northern Nigeria, TB/HIV co-infection was significantly associated with marital status,
WHO clinical stage and CD4 count[6].

Evidence from prospective observational study in Mulago Hospital, Uganda; showed that female
sex and baseline BMI ≤ 20 predicted incidents of TB in TB-HIV co-infections among patients
with ART[25].

As the cross-sectional study carried out at the HIV clinic of Jos University Teaching Hospital,
Nigeria on 218 consecutive adult patients over a 7-month period shows, being WHO clinical
stage 3 or 4, having HBV co-infection, oropharyngeal candidiasis, chronic diarrhea and Kaposi’s
sarcoma were the risk factors[26].

The retrospective review analysis of patient medical records in Hawassa University Referral
Hospital, found that, from a total of 499 HIV/AIDS positive patient medical records reviewed;
being female, WHO clinical stage 3, WHO clinical stage 4, functional status being ambulatory
and poor INH prophylactic management were independently associated with TB-HIV co-
infection[14].

According to the retrospective follow-up study conducted at the government owned General
Hospital located in Arba Minch town, Southern Ethiopia;496 records of HIV Infected patients
analyzed and determined that family size, history of cigarettes smoking, WHO baseline clinical
stage, hemoglobin level, age in group, addiction, sex of respondent, CD4 count, ART
intervention, type of initial regimen and past history of TB treatment were significant risk factors
for development of tuberculosis among HIV infected patients[27].

The hospital based retrospective studies conducted among 571 adult HIV-positive patients
attending HIV clinic in Amhara region explored that lower baseline CD4 count<200cell/μl,
patients who drunk alcohol, patients who were ambulatory at the initiation of ART, patients
whose marital status was single were significant predictors for increased risk of tuberculosis in
PLWHIV. Nonsmoker patients, patients in WHO clinical stage I, patients in WHO clinical stage
II and ownership of the house had significant protective benefit against risk of TB[22].

The institutional based cross-sectional study conducted among a total of 385 HIV cases to assess
magnitude of tuberculosis and its associated factors among HIV patients at FelegeHiwot Referral

6
Hospital in Bahirdar city declared that body mass index (BMI)less than 18.5, CD4 count less
than 200 and functional status bed redden and ambulatory were significant predictors of TB[28].

A case control study conducted in 2 public hospitals and 13 health centers in Addis Ababa found
that the presence of isoniazid and cotrimoxazole prophylaxis had protective benefit against risk
of TB. In contrary, bedridden, having WHO clinical stage III/IV and hemoglobin level, 10 mg/dl
at enrollment to ART care were predictors for increased risk of tuberculosis in PLWH after ART
initiation[29].

According to the case-control study conducted among 123 TB infected HIV positives in
Nekemte, western Ethiopia. Being divorced/widowed, not attending formal education, being
underweight (BMI < 18.5 kg/m2), having history of diabetic mellitus, and being in advanced
WHOHIV/AIDS clinical staging were determinant factors associated with TB/HIV co-
infection[30].

7
 CHAPTER THREE: OBJECTIVE

3.1General Objective:

To determine the prevalence and factors affecting the development of the active - TB infection
among HIV positive patients in ART clinic at WSUCSH from April to August 2022.

3.2 Specific objective:

 To determine the prevalence of active TB among RVI patients.

 To assess factors affecting the development of active TB among RVI patients

8
 CHAPTER FOUR: METHODOLOGY

4.1. Study setting and study period

The study will be conducted at WSUCSH, which is located in Wolaita town, Wolaita zone
southern Nations, Nationalities and people Region (SNNPR). Wolaita is 328 km far from capital
city of Ethiopia(Addis Ababa). WSUCSH is serving the people in catchment area of 3 million
people including neighboring Dwuro, Gamo, Gofa and KambataTambaro zones and other. The
Hospital serving over 100,000 outpatient visitors in a year. The hospital has 7 pharmacies which
renders service for Inpatient, Emergency, Outpatient, Gynecology, Ophthalmology, OR and
Anti-retroviral (ART)pharmacy.

The study will be conducted to determine the prevalence and factors affecting the development
of active-TB infection among HIV/AIDS patient in ART clinic from April to Aug ,2022 on
patient medical records of RVI (HIV sero-positive) patients.

4.2 Study design

Retrospective cross-sectional study design will be conducted in ART clinic of WSUCSH to
determine the prevalence and factors affecting the development of active-TB infection among
HIV/AIDS patient by reviewing patient medical records of all RVI patients during the study
period.

4.3 Population
4.3.1 Source population
All RVI (all HIV sero-positive) patients.

4.3.2 Study population

RVI patients who were on the ART April-Aug, 2022E.C

4.4 Inclusion and exclusion criteria

4.4.1 Inclusion criteria
 All RVI patients card registered on ART during study period.

4.4.2 Exclusion criteria

 Cards of the Patients those develop active TB before HIV infection is confirmed because
it is categorized as HIV among TB, not TB among HIV.

9
  Unreadable patient cards.
 Patient cards with incomplete information.

4.5 Sample size determination and Sampling technique

4.5.1 Sample size determination
Using a single mean formula, the sample size will be determined as follows

Z ² XP(1− p)
ni =
d²

Where,

n is the required sample size;

d is the marginal error that is 5% (d=0.05);

p is the proportion of prevalence of active-TB among patients living with HIV/AIDS who came
to WSUCSH (0.5 [50%]);

z is the required degree of accuracy at 95% confidence level =1.96. Using the above formula:

(1.96)² X 0.5(1−0.5)
¿= =384
0.05²

Since the sample was taken from the total population of 1664 PLWHA who have been taking
ART, since it is < 10,000, the final sample size was determined after using the correction factor.
So that,

niX N
nf= ¿+(N −1)

384 X 1664
nf= 384+(1664−1) =312

When 5% contingency is added, the total sample size will be 327. Accordingly, 327samples will
be taken from WSUCSH.

4.5.2 Sampling technique

A simple random sampling method will be adopted for selecting a representative sample.

10
4.6 Data Collection Method
4.6.1 Data collecting instrument and procedure
Data collection format which contain patient’s socio-demographic characteristics and clinical
and laboratory profile of study participants will be utilized for the study. The data will be
collected by using structured questionnaires and data will be collected by reviewing patients’
medical records. The questionnaire will be prepared in English language including all relevant
variables based on the objectives of the study. The collected data will be checked for
completeness. Data collection questionnaire papers, pen and pencil will be used during data
collection.

4.7 Study Variables

4.7.1 Dependent Variables:
 The occurrences of TB in HIV infected patients.
4.7.2 Independent Variables
 Patient demographics (age, sex, education status, religion, residence, ethnic
 Patient’s clinical conditions (including WHO clinical stages and co-morbidities)
 Laboratory profiles (including CD4 counts and other laboratory tests).

4.8 Operational definitions

Active tuberculosis: Active tuberculosis refers to disease that occurs in someone infected with
Mycobacterium tuberculosis that is characterized by signs or symptoms of active disease, or
both, and is distinct from latent tuberculosis infection, which occurs without signs or symptoms
of active disease.

HIV (Human Immunodeficiency Virus): is a virus that attacks the immune system, the body's
natural defense system. A retrovirus, human immunodeficiency virus type 1
(HIV-1), is the major cause of AIDS. A second retrovirus, HIV-2, also is recognized to cause
AIDS, although it is less virulent, transmissible, and prevalent than HIV-1.

 retroviruses are transmitted primarily by:

 sexual contact and by contact with infected blood or blood products as well as
from childbearing women to their offspring.

11
Tuberculosis (TB): is a chronic bacterial an infectious disease caused by the bacterium
Mycobacterium tuberculosis (MTB).
 Less frequently, it can be caused by M. bovis and M. africanum.
 TB usually affects the lungs (pulmonary TB) and All parts of the body can be infected
(EPTB). extra-pulmonary sites affected the lymph nodes, pleura, spine, urinary tract, the
brain, joints, bone and abdomen

4.9 Data quality control

The data will be collected by the principal investigator. Before starting the data collection, data
collecting format will be cross matched with available information on records; then the study
questions rearranged as necessary. Incomplete chart will be discarded. The data will be cleared
and checked every day for completeness and consistency before data processing and analysis

4.10 Data collection process& analysis

After data collection, the data will be coded, edited and cleaned to ensure accuracy, consistency
and completeness before entering into computer statistics program. After that categorized and
analyzed by using SPSS 20 computer software package. Quantitative data will be completed and
interpretation will be done according to the finding of the study data will be presented in tables
and figures.

4.11 Dissemination of the results

After the completion of the study, the result will be compiled and given to School of Pharmacy
College of Health and Medical Science of Wolaita Sodo University and other concerned bodies.

12
 CHAPTER FIVE: WORK PLAN

Table 1: Work plan of Assessment of prevalence and factor affecting the development of active-
TB infection among HIV/AIDS patient in ART clinic at WSUCSH

N0 Activities Responsible July Aug Sep Oct Nov

Body 2022 2022 2022 2022 2022.

1 Topic Principal
Selection investigator&
advisor
2 Obtaining PI and advisor
ethical
clearance
3 Searching of PI and advisor
Literatures
4 Proposal PI and advisor
development
5 Data collection PI and advisor

6 Data entry, PI and advisor

analysis and
interpretation
7 Summation of PI and advisor
final work

13
 CHAPTER SIX: BUDGET

6.1 Detail Budget

Table 2: Budget required for assessment of prevalence and factors affecting the development of
active-TB infection among HIV positive patient in ART clinic at WSUCSH

No Item Unit Quantity Unit price Total price

Birr Cents Birr Cents
1 Pen Pcs 10 10 00 100 00
2 Pencil Pcs 5 6 00 30 00
3 Steeples Pcs 1 70 00 70 00
4 Sharpener Pcs 4 3 00 12 00
5 Note book Pcs 2 150 00 300 00
6 Printing Page 500 3 00 1500 00
7 Thesis binding Pcs 5 25 00 125 00

Subtotal 2137 00

14
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15.WHO. Guidelines for clinical and programmatic management of TB, TB/HIV, DR-TB and
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Hospital, Ethiopia. Iranian Journal of Public Health. 2017;46(1):130-2.

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24. Kaze AD, Ilori T, Jaar BG, Echouffo-Tcheugui JB. Burden of chronic kidney disease on the
African continent: a systematic review and meta-analysis. BMC nephrology. 2018;19(1):1-11.
25. Nakanjako D, Mayanja-Kizza H, Ouma J, Wanyenze R, Mwesigire D, Namale A, et al.
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 ANNEX
Data collection format (Check list)
WOLAITA SODO UNIVERSITY
COLLEGE OF MEDICINE AND HEALTH SCIENCE
DEPARTMENT OF PHARMACY
I. Socio-demographic characteristic (patient information):
1. Patient card number………. Weight.............
2.Sex: A. Male B. Female
3.Religion:
A. Muslim B. Orthodox C. Protestant D. Catholic E. Others
4. Age (Years):
A. <5 yrs B. 6 yrs-15 yrC.16 yrs - 54 yrs
D.55 yrs - 65 yrs E. >65 yrs
5. Occupation:
A. Government employees B. Farmer C. Merchant
D. Students E. House wife F. Soldiers
6. Educational status:
A. Illiterate B. Primary school C. Secondary school D. Tertiary
7. Marital status:
A. Unmarried B. Married C. Divorced D. Widow
8. Residence:
A. Urban B. Rural C. Ethnicity
9. Family size
A. <2 B. 3-4 C. >5
10. Family history of TB
A. Yes B. No
11. Khat chewing
A. Yes B. No
12. Smoking status
A. Yes B. No

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13. Alcohol intake
A. Yes B. No
II. Clinical and laboratory profile of study participants;
1. CD4 count levels when TB developed:
A. < 200 B. 200 - 350C. 350 - 500 D. >500
2. WHO HIV/AIDS Stage of disease when TB developed:
A. Stage - I and II B. Stage – III C. Stage - IV
3. Tuberculosis diagnosis in HIV/TB co-infected Patients:
A. AFB positive B. C-Xray suggestive of TB C. Mantoux positive
4. TB category:
A. Pulmonary TB B. Extra pulmonary TB
5. Symptoms at presentation (multiple response applicable):
A. Cough B. Fever
C. Weight loss D. Distended abdomen E. Others (night sweats, stunted growth)
6. ART status prior to diagnosis
A. On HAART B. Not on HAART
7. CD4 level at ART initiation:
A.<200 B. 200 – 350 C.350 -500 D.>500
8. Prophylaxis for TB, if used:
A. INH B. R C. Others D. No
9. Functional Status of the patients:
A. Working B. Ambulatory C. Bedridden
10. CD4 level at anti-TB initiated:
A. <200 B. 200-350 C.350-500 D.>500
11. Anti-TB discontinued:
A. yes B. No
12. If yes, on (no-11) reasons:
A. Cured B. Death
13. Drug adherence:
A. Good B. Poor
14. Comorbidities
A. Yes B. No
15. IPT
A. Yes B. No
16. Cotrimoxazole prophylaxis
A. Yes B. No

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