The Effect of HIV Co-Infection to the Mortality of Tuberculosis Patients In Denpasar, Bali, Indonesia

Artawan Eka Putra, I Wayan Gede

The Effect of HIV Co-Infection to the Mortality of Tuberculosis Patients In Denpasar, Bali, Indonesia

Tuesday, 19 August 2014

Exhibit hall (Dena'ina Center)

I Wayan Gede Artawan Eka Putra, MD , School of Public Health, Faculty of Medicine, Udayana University, Denpasar, Indonesia

Putu Ayu Swandewi Astuti, MD , School of Public Health, Faculty of Medicine, Udayana University, Denpasar, Indonesia

Made Pasek W Kardiwinata, MPH , School of Public Health, Faculty of Medicine, Udayana University, Denpasar, Indonesia

I Made Kerta W Duana, MPH , School of Public Health, Faculty of Medicine, Udayana University, Denpasar, Indonesia

Cok Istri Sri Dharma W Astiti, BS , Health Office of Bali Province, Denpasar, Indonesia

I Made W Sutarga, MD , School of Public Health, Faculty of Medicine, Udayana University, Denpasar, Indonesia

INTRODUCTION: The major issue of tuberculosis (TB) control program in Denpasar which is the city with the highest TB case notification rate (CNR) in Bali Province is the increasing of mortality from 7.9% in 2011 to 10.2% in 2012. Furthermore, Bali is the fourth highest prevalence of human immunodeficiency virus (HIV) infection in Indonesia and Denpasar is the highest in Bali. We aimed to identify the effect of HIV co-infection to the mortality of TB patients in Denpasar, Bali.

METHODS: This is a health facilities based cohort study that was conducted in 2 years between January, 2011 and December 2012. The population is all TB patients with HIV testing history that were categorized into HIV co-infected and non HIV co-infected cohorts. A Chi-square test used to compare the characteristic between the two groups. A cohort study risk-ratio was used to compare the mortality between the two groups. A Poisson regression analysis was used to identify the independent effect of HIV co-infection to the mortality of TB patients.

RESULTS: From 2011-2012, there were 865 TB patients with HIV testing history and 207 (23.9%) of them were HIV co-infected. The distribution of the characteristics (age groups, sex and TB classifications) between the two groups were significantly different. The mortality of TB patients among HIV co-infected were 28.5% compare to 7.9% among non HIV co-infected, crude risk-ratio (CRR) = 3.6; (95%) CI: 2.6 – 5.1. The independent effect of HIV co-infection to the mortality of TB patients: adjusted risk-ratio (ARR) = 3.9; (95%) CI: 2.7 – 5.8.

CONCLUSIONS: HIV co-infection is the main factor effected to the mortality of TB patients. The early detection and prompt treatment of TB-HIV co-infection is needed trough the improvement of the TB-HIV collaboration program performance.