Characteristics and treatment outcomes of adolescents and young adults living with HIV with drug-resistant tuberculosis co-infection in Uganda: a retrospective cohort study.

Abstract

Background: Tuberculosis (TB) remains a significant global health challenge, especially among people living with HIV. Drug-resistant TB (DR-TB) complicates treatment outcomes in high-burden countries like Uganda, particularly for adolescents and young adults living with HIV (AYALH).

Objectives: We described the characteristics, treatment outcomes, and factors associated with treatment success among AYALH and DR-TB at a TB treatment unit in Mulago National Referral Hospital, Kampala, Uganda.

Design: A retrospective cohort study was conducted.

Methods: Medical records of AYALH treated for DR-TB between January 2013 and December 2021 were reviewed. Descriptive statistics and multivariable logistic regression were used to analyze treatment outcomes and associated factors.

Results: Among 327 participants (mean age: 28.2 years, SD: 4.75; 52.6% male), the treatment success rate was 65.7%. A body mass index (BMI) ⩾ 18.5 kg/m² (adjusted odds ratio [aOR]: 0.53, 95% CI: 0.33-0.83, p = 0.005), Efavirenz-based antiretroviral therapy (ART) regimens (aOR: 0.56, 95% CI: 0.35-0.89, p = 0.014), and primary DR-TB (aOR: 0.42, 95% CI: 0.28-0.64, p < 0.001) were significantly associated with treatment success.

Conclusion: The study revealed a treatment success in only two-thirds of participants emphasizing persistent challenge of achieving optimal treatment outcomes for AYALH. The findings highlight that a higher BMI and Efavirenz-based ART regimens are significantly associated with improved treatment success pointing to the necessity for addressing nutritional needs and optimizing ART regimens to improve the management of DR-TB among AYALH.