The in-hospital tuberculosis diagnostic cascade and early clinical outcomes among people living with HIV before and during the COVID-19 pandemic - a prospective multisite cohort study from Ghana

Johanna Åhsberg*, Stephanie Bjerrum, Vincent Jessey Ganu, Augustine Kwashie, Joseph Oliver Commey, Yaw Adusi-Poku, Peter Puplampu, Åse Bengård Andersen, Ernest Kenu, Margaret Lartey, Isik Somuncu Johansen

*Kontaktforfatter

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

15 Downloads (Pure)

Abstract

Objectives: The COVID-19 pandemic had a disruptive impact on tuberculosis (TB) and HIV services. We assessed the in-hospital TB diagnostic care among people with HIV (PWH) overall and before and during the pandemic. Methods: In this prospective study, adult PWH admitted at three hospitals in Ghana were recruited if they had a positive World Health Organization four-symptom screen or one or more World Health Organization danger signs or advanced HIV. We collected data on patient characteristics, TB assessment, and clinical outcomes after 8 weeks and used descriptive statistics and survival analysis. Results: We enrolled 248 PWH with a median clusters of differentiation 4 count of 80.5 cells/mm3 (interquartile range 24-193). Of those, 246 (99.2%) patients had a positive World Health Organization four-symptom screen. Overall, 112 (45.2%) patients obtained a sputum Xpert result, 66 (46.5%) in the prepandemic and 46 (43.4%) in the pandemic period; P-value = 0.629. The TB prevalence of 46/246 (18.7%) was similar in the prepandemic 28/140 (20.0%) and pandemic 18/106 (17.0%) population; P-value = 0.548. The 8-week all-cause mortality was 62/246 (25.2%), with no difference in cumulative survival when stratifying for the pandemic period; log-rank P-value = 0.412. Conclusion: The study highlighted a large gap in the access to TB investigation and high early mortality among hospitalized PWH, irrespective of the COVID-19 pandemic.

OriginalsprogEngelsk
TidsskriftInternational Journal of Infectious Diseases
Vol/bind128
Sider (fra-til)290-300
ISSN1201-9712
DOI
StatusUdgivet - mar. 2023

Bibliografisk note

Funding Information:
The authors are most grateful to the patients, hospital management, and staff of Lekma Hospital, Tema General Hospital and Korle-Bu Teaching Hospital who participated in this study. The authors thank research assistants at the study sites; the staff at the Chest Clinic and Fevers Unit Laboratories, Korle-Bu Teaching Hospital; staff at the National Public Health and Reference Laboratory, Korle-Bu; key personnel at the National TB Control Programme in Ghana; and Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark for their support during the study.

Funding Information:
J.Å. received grants from Julie von Müllens fond, Læge Agnethe Løvgreens legat, Torben og Alice Frimodts fond, A.P. Møller fonden, University of Southern Denmark Faculty of Health Sciences Ph.D. scholarship, University of Southern Denmark traveling fund, the Region of Southern Denmark, and Odense University Hospital Internationalization fund. I.S.J. received grants from the Strategic Research Council, Region of Southern Denmark. The funding sources had no influence on the study design, data collection, analysis, interpretation of the data, or the writing of the manuscript.

Fingeraftryk

Dyk ned i forskningsemnerne om 'The in-hospital tuberculosis diagnostic cascade and early clinical outcomes among people living with HIV before and during the COVID-19 pandemic - a prospective multisite cohort study from Ghana'. Sammen danner de et unikt fingeraftryk.

Citationsformater