RESUMO
Introduction: Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) remain major public health issues in sub-Saharan Africa. The co-occurrence of these diseases is a growing concern in the region, and social determinants, the circumstances under which people are born, live, work, and age, are known to influence the risk of disease transmission, diagnosis, treatment, and outcomes. Here, we present a protocol for the evidence synthesis on the social determinants of HIV/TB coinfections in sub-Saharan Africa. The high prevalence of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) in sub-Saharan Africa presents significant public health challenges. TB/HIV comorbidity is influenced by various social determinants, including social, economic, cultural, and environmental factors, impacting disease transmission risk, accurate diagnosis, and treatment outcomes. This study protocol aims to provide an evidence synthesis on the social determinants of HIV/TB coinfection in sub-Saharan Africa. Methods and analysis: The researchers will use the Arksey and O'Malley's (2005) methodological framework to guide the scoping review. First, databases such as PubMed, MEDLINE, Web of Science, and PsychInfo will be searched. The researchers will then proceed in two steps. Before finalising the study selection, two independent reviewers will examine the article titles and abstracts for eligibility and inclusion. The researchers will then conduct a full-text screening of the articles based on the selected titles and abstracts. The authors' tool will be used to extract data, ensuring that the articles are properly screened and that the risk of bias is minimized. The chosen studies will be examined using a standardized tool to examine all bibliographic data and study characteristics. Ethics and dissemination: The review will provide an overview of the social determinants influencing the prevalence and outcomes of TB/HIV comorbidity in the region, as well as identify any research gaps. Policymakers, researchers, and healthcare professionals will benefit from the findings in developing targeted interventions to address the social determinants of TB/HIV comorbidity in sub-Saharan Africa.
RESUMO
Tuberculosis (TB) is one of the oldest human diseases, and preventing treatment failure is critical. This is because TB cases pose a risk to the immediate and remote communities due to the potential for spread, particularly for multidrug-resistant (MDR) strains that have been associated with higher morbidity and mortality rates. Hence, this study looked at the factors that influence TB treatment outcomes in Southwest Nigeria. We conducted a cross-sectional study with 712 TB patients from 25 directly observed treatment short course (DOTS) centers, out of which 566 (79.49%) were new treatment cases, and 102 (14.33%) were retreatment cases. The outcome variable was computed into successful treatment where 'Yes' was assigned to TB treatment completed and cured, and 'No' was assigned to all the remaining outcomes following the standard TB definition. Independent variables included in the analysis were the patient's socio-demographic characteristics (such as age, sex, distance from the facility, marital status, family type, education, and computed socioeconomic status from modified DHS household assets), clinical and facility parameters (such as the HIV status, facility of access to healthcare, healthcare workers attitudes, services offered at the facility, appearance of the facility, number of people seeking care and waiting time at the facility). Bivariate analysis showed that HIV status (OR: 3.53, 95% CI: 1.83-6.82; p = 0.001), healthcare worker attitude (OR: 2.13, 95% CI: 1.21-3.74; p = 0.01), services offered at the facility (OR: 0.67, 95% CI: 0.49-0.92; p = 0.01), appearance of facility (OR: 0.67, 95% CI: 0.46-0.98; p = 0.04), and number of people seeking care (OR: 2.47, 95% CI: 1.72-3.55; p = 0.001) were associated with higher odds of successful treatment outcome with statistical significance. After multivariate analysis, reactive HIV status (aOR: 3.37, 95% CI: 1.67-6.80; p = 0.001), positive attitude of healthcare workers (aOR: 2.58, 95% CI: 1.36-4.89; p = 0.04), excellent services offered at the healthcare facility (aOR: 0.53, 95% CI: 0.36-0.78; p = 0.001) and few people seeking care (aOR: 2.10, 95% CI: 1.21-3.84; p = 0.001) became independent significant determinants of successful treatment outcome. The study concluded that reactive HIV status, positive attitude of healthcare workers, few people seeking healthcare, and excellent service provided were all factors that contributed to successful treatment outcomes.