Clinical and Psychosocial Determinants of Patients with Tuberculosis/Human Immunodeficiency Virus Co-Infection: A Structural Equation Model Approach.

ABSTRACT

BACKGROUND: Tuberculosis (TB)/human immunodeficiency virus (HIV) co-infection is a complex mesh of physical and psychosocial disorders that require a multimodal and multifaceted approach for improved outcomes. AIMS: This study determined the treatment outcomes of patients with TB/HIV co-infection and the clinico-psychosocial predictors of the disease over a 10-year period in resource-limited settings. PATIENTS AND METHODS: This study reviewed the 10-year retrospective treatment outcomes of patients with TB/HIV co-infection in a tertiary centre. The data were retrieved from the TB treatment registers and analyzed with STATA 16.0. The effects of latent constructs of high clinical severity, stigmatization, and family stress/burden on treatment outcomes were evaluated using a structural equation model. RESULTS: Of the 1,321 who met the inclusion criteria, 1,193 had sufficient data. The mean age of the patients was 38.2 ± 16.7 years. The treatment adherence rate over the 10 years was 93.8% (±6.8%) but successful treatment outcome was 75.5% (±8.1%). Stigmatism of TB/HIV infections was experienced by adults and males (ß = 0.972; P < 0.001 ß = 0.674; P < 0.001, ß = -0.770; P < 0.001, respectively), non-adherent to treatment (ß = -0.460; P < 0.001) clinical severity of illness (ß = 0.940; P < 0.001), and being HIV negative (ß = -0.770; P < 0.001). Family Stress/Burden was strongly affected by both Death (ß = 1.000; P < 0.001) and higher Stigmatism (ß = 0.602; P < 0.001). Clinical severity of illness significantly influenced both Death and Unsatisfactory outcomes (ß = 0.207; P < 0.001, ß = 0.203; P < 0.05, respectively). Non-Adherence led to potentially unsatisfactory outcome. CONCLUSION: TB/HIV co-infection is a complex psychosocial disorder that is significantly and negatively impacted by social determinants of the disease. A holistic approach to treatment intervention that addresses the latent factors of stigmatization, family stress/burden, and high clinical severity is key to achieving a successful treatment outcome.