Asian Journal of Medical Principles and Clinical Practice

4(4): 96-101, 2021; Article no.AJMPCP.75339

Prevalence and Knowledge of Tuberculosis among

HIV Patients Accessing Care at Abia State University
Teaching Hospital, Nigeria
E. C. Iwuoha1*
1Department of Community Medicine, Abia State University Teaching Hospital, Aba, Nigeria.

Author’s contribution

The sole author designed, analysed, interpreted and prepared the manuscript.

Article Information

Editor(s):
(1) Dr. Kumud Kumar Kafle, Tribhuvan University, Nepal.
Reviewers:
(1) Md. Abdullah Yusuf, National Institute of Neurosciences & Hospital, Bangladesh.
(2) Muhammad Aamir Safdar, Pakistan.
Complete Peer review History: https://www.sdiarticle4.com/review-history/75339

Received 10 August 2021

Original Research Article Accepted 19 October 2021
Published 19 October 2021

ABSTRACT

Background: TB infection is one of the leading causes of death among HIV patients because of
the burden of TB HIV co-infection on the immunity of affected persons. Estimation of the
prevalence of TB among these clients will enhance screening, early diagnosis and treatment. In
addition, knowledge of TB among these clients is of relevance to their care.
Objectives: The study aimed at assessing the prevalence and knowledge of tuberculosis among
HIV patients accessing care at Abia State University Teaching Hospital (ABSUTH) Aba.
Materials and Methods: This was an institutional-based cross-sectional, descriptive study
involving 315 patients who accessed HIV care at Abia State University Teaching Hospital from
June to September 2019. Data was obtained from the patients using semi-structured
questionnaires which were self- administered within the period of study and analyzed using IBM
SPSS version 22.0. Statistical significance was set at P-value of < 0.05.
Results: A total of 315 HIV patients assessing care at ABSUTH participated in the study; 66.0%
were females and 34.0% were males with 40.0% within the age of 26-35 and about 40.0% were
married. All the patients had heard of tuberculosis and 43.8% knew the cause of tuberculosis while
56.8% knew how it could be contracted. Prevalence of TB in the study population was 30.8%.
Patient’s educational level and awareness of risk of TB among HIV patients showed statistically
significant relationship with previous treatment for TB (p=0.03 and 0.04 respectively).
_____________________________________________________________________________________________________

*Corresponding author: E-mail: driwuoha@gmail.com;

 Iwuoha; AJMPCP, 4(4): 96-101, 2021; Article no.AJMPCP.75339
Keywords: HIV; tuberculosis infection; prevalence.
1. INTRODUCTION
Estimates of the burden of TB in Nigeria relied
solely on indirect assessment by the World
Health Organization (WHO) based on existing TB
surveillance data until 2012 when the first
National TB prevalence survey was done. The
survey became necessary because accuracy of
such estimates largely depends on the quality of
the routine surveillance information, which in
itself is affected by the completeness of TB
notification and instances of TB under-diagnosis
[1]. Nigeria has the fourth biggest tuberculosis
(TB) epidemic in the world. Approximately 4% of
global TB cases occur in Nigeria [2] Tuberculosis
is an extremely contagious disease which can
affect virtually every organ, most importantly the
lungs. Pulmonary complications have been one
of the commonest causes of morbidity and
mortality among patients infected with the
Human immunodeficiency virus (HIV) [3].
Infection with both HIV and TB is called HIV/TB
co-infection. Latent TB is more likely to advance
to TB disease in people with HIV than in people
without HIV. The presence of TB disease may
also cause HIV to worsen. TB is the most
common opportunistic disease which kills those
infected with Human Immunodeficiency Virus
(HIV). Recently, WHO reported that 12% of the
9.6 million new TB cases were HIV positive [4].
The TB epidemic in Nigeria is closely linked to
HIV. Nigeria is one of ten countries that together
are home to 80% of people living with HIV and
TB co-infection [2].
Various TB/HIV co-infection rates have been
reported in Nigeria with a study in 2014 in Lafia
Nassarawa State recording a prevalence as high
as 34.5% [5]. The prevalence of TB among HIV
sero-positive individuals at Abia State University
teaching hospital; a referral hospital could
expectedly be high due to the high number of
patients treated in the TB-HIV care unit.
Therefore, this study will help assess the
prevalence in the study area and help to design
regular surveillance techniques of TB infection in
HIV patients. This will assist physicians in
identifying major determinants of TB in HIV
patients and expect these disease infectious
trends ahead of time to manage them.
This study will also provide information for health
authority on the prevalence of TB in HIV patients
at Abia State University teaching Hospital, so
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that it would give a better emphasis to TB/HIV
collaborative activities and serve as reference
document for further studies in the area.
2. MATERIALS AND METHODS
This was an institutional-based cross-sectional,
descriptive study involving 315 patients who
accessed HIV care Abia State University
Teaching Hospital from June to September 2019.
The research work was carried out at the heart to
heart (HIV) clinic of this hospital located in
Osisioma Local Government Area in Abia state
of Nigeria. All consenting adult patients
accessing care during the period of the study
were included in the study. Self/interviewer
administered questionnaires were administered
to these patients on each clinic day until sample
size was achieved.
The national TB control program defines: (1)
“Cured” as a patient who was initially sputum
smear positive, has completed treatment and
had negative sputum smears on two occasions,
one of which is at the end of the treatment. If at
the end of treatment, sputum smear is not done,
the patient is classified as “treatment completed”
[6].
2.1 Data Management Data
Data was entered, cleaned and analysed using
IBM SPSS version 20.0. Frequencies were
calculated for descriptive analysis of socio-
demographic variables (age, sex, marital status,
educational status and occupation. Statistical
significance was set at a P-value < 0.5.
3. RESULTS
A total of 315 correctly filled questionnaires
received from the correspondents were analysed
and results presented below.
Table 1 shows the sociodemographic data of the
participants. Respondents comprising 66.0%
female and 34.0% males participated and were
mostly between the age of 26 and 45 years
(77%). Most of them were married with 52%
having secondary level of education, and about
37.1% were traders.
 Iwuoha; AJMPCP, 4(4): 96-101, 2021; Article no.AJMPCP.75339

Table 1. Sociodemographic variables of respondents

Variable Frequency (N= 315) Percent (%)

Age group (in years)
< 25 43 13.7
26 to 35 126 40.0
36 to 45 85 37.0
above 45 61 19.4
Gender
Male 107 34.0
Female 208 66.0
Marital status
Single 97 30.8
Married 134 42.5
Divorced 40 12.7
Widowed 39 12.4
Separated 5 1.6
Religion
Christianity 269 85.4
Islam 40 12.7
Others 6 1.9
Level of Education
No Formal Education 21 6.7
Primary 51 16.2
Secondary 165 52.4
Tertiary 78 24.8
Occupation
Unemployed 22 7.0
Farmer 33 10.5
Trader 117 37.1
Artisan 49 15.6
Civil Servant 40 12.7
Students 30 9.5
Others 24 7.6

Table 2. Knowledge of TB among respondents

Variable Frequency Percent (%)

N 315
Have Heard of Yes 315 100.0
Tuberculosis No 0 0
Causes Tuberculosis Fungi 3 1.0
Bacterial 138 43.8
Virus 92 29.2
I don’t know 82 26.0
How Tuberculosis Shaking Hands 10 3.2
Spreads Sharing Toothbrush 49 15.6
Kissing 30 9.5
Coughing 179 56.8
Sneezing 47 14.9
HIV Patients Are Prone Yes 287 91.1
to Tuberculosis No 28 8.9
Tuberculosis is Curable Yes 274 87.0
No 5 1.6
Am not sure 36 11.4
Duration of Treatment for 6 months and above 192 61.0
TB Less than 6 months 31 9.8
Don’t know 92 29.2

Table 2 above shows respondents’ knowledge of as the cause of tuberculosis while 30.2% said it
tuberculosis. All respondents had heard of was caused by fungi and 29.0% by virus and
tuberculosis and about 43.8% identified bacteria about 26% had no idea of the cause of TB. About

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 Iwuoha; AJMPCP, 4(4): 96-101, 2021; Article no.AJMPCP.75339

91.1% knew that HIV patients are prone to
tuberculosis. They differed in their knowledge of
spread of TB with about 56.8% identifying
“coughing” as a means of transmission.
Table 3 shows the prevalence of Tuberculosis
among the respondents. Ninety seven (30.8%) of
them had previously been diagnosed with
Tuberculosis. Those were currently on anti TB
drugs were 14.4% while about 85.6% had been
treated previously. Among those who had been
treated, 72% completed 6months of ant-TB
treatment while 28% said they were treated for
more than 6 months.
Table 4 shows association between previous
treatment for TB and socio-demographic
variables of the patients. Patient’s educational
level and awareness of risk of TB among HIV
patients showed statistically significant
relationship with previous treatment for TB
(p=0.03 and 0.04 respectively).

Table 3. Prevalence of TB

Variable Frequency (N) Percent

Diagnosed with TB
Yes 97 30.8
No 218 69.2
Currently has TB
Yes 14 14.4
No (Previously treated for TB) 83 85.6
Total 97 100
Duration of treatment for
Previously Treated
6 months 60 72.3
>6 months 23 27.3
Total 83 100
Declared cured for TB (for
Previously treated)
Yes 76 91.6
No 7 8.4
Total 83 100
Current TB Treatment
Yes 14 100

Table 4. Association between previous treatment for TB and Socio-dermograhic variables

Variables Previous Treatment for TB χ2 P-value

Yes (N%) No (%)
Age group (in yrs)
<15-25 9(10.8) 34(14.7) 4.016 0.260
26-35 29(34.9) 97(41.8)
36-45 29(34.9) 56(24.1)
>45 16(19.3) 45(19.4)
Sex
Male 29(34.9) 78(33.6) .047 0.820
Female 54(65.1) 154(66.4)
Education
No Formal 4(4.8) 17(7.6)
Primary 10(12.0) 41(17.7) 8.755* 0.030**
Secondary 55(66.3) 110(47.4)
Tertiary 14(16.9) 64(27.6)
Awareness of HIV
Patients at Risk of
TB
Yes 80(96.4) 207(89.2)
No 3(3.6) 25(10.8) 30.318* 0.040**
*Fisher’s test; **Statistical significance

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 Iwuoha; AJMPCP, 4(4): 96-101, 2021; Article no.AJMPCP.75339
4. DISCUSSION
TB is a well-recognized opportunistic infection in
patients with HIV/AIDS. The prevalence of HIV
was higher among the female patients (66.0%) in
this study as has been similarly documented in
previous studies especially in Africa; 66.5% in
Nigeria and 61% in South Africa [7,8]. Poor
knowledge of TB amongst people living with HIV
is associated with high transmission and delay in
health-seeking behaviour [9]. However all
respondents in this study were aware of
tuberculosis with 91% aware of the fact that HIV
patients were prone to having TB while 87%
knew that TB was curable though only about
57% knew correctly how TB was transmitted.
This knowledge of TB among the study
population could be attributed to daily health
education on Tuberculosis carried out at the HIV
clinic in this facility.
In this study, we found that TB prevalence
among these HIV patients was 30.8%. Similarly,
high prevalence has been reported from Nepal
(27.3%) and Nigeria (22.7%, 26.7%) [10,11,12].
This finding was however lower than other
studies conducted in India (17%), Nigeria
(16.8%, 14.4%, 9.6%) [13-16]. Much lower
results have been reported in Northern Tanzania
(8.3%) [17]. Variations in the magnitude of
tuberculosis in HIV/AIDS patients may be due to
differences of HIV infection rate in the population,
TB- diagnostic facilities available, health care
awareness of the community to seek health care
for both TB and HIV.
Level of education in this study had statistically
significant relationship with previous treatment
for TB. Majority of the study participants had
secondary level of education and are likely to
understand better enlightenment on signs and
symptom of TB as well as the need to present for
treatment if diagnosed with TB. A study in
Ethiopia corroborated the role of education on TB
among HIV patients [18]. Closely related to this is
the high awareness among these respondents
on the risk of TB among HIV patients (over 90%
of respondents). Awareness of this risk was
statistically significant and goes further to
emphasize the role of TB education in the care of
HIV patients who are at risk of HIV as a result of
compromised immunity [19]. TB outcomes are
also likely to be better among these informed HIV
patients as they are less likely to default [18].
5. CONCLUSION
We conclude that prevalence of tuberculosis in
this study was high. Previous treatment for
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tuberculosis was associated with level of
education and awareness of TB risk among HIV
patients. The working age was more affected and
prevalence was higher among females.
6. RECOMMENDATION
Education of HIV patients on the prevalence of
TB, TB prevention and treatment will go a
long way in improving HIV care and decreasing
the prevalence of TB among HIV patients.
Education of health-workers on TB care and best
practices will also be relevant in this regard.
DISCLAIMER
The products used for this research are
commonly and predominantly use products in our
area of research and country. There is absolutely
no conflict of interest between the authors and
producers of the products because we do not
intend to use these products as an avenue for
any litigation but for the advancement of
knowledge. Also, the research was not funded by
the producing company rather it was funded by
personal efforts of the authors.
ETHICAL APPROVAL AND CONSENT
Ethical approval for this study was obtained from
the Ethical and review committee of Abia State
University Teaching hospital while confidentiality
of patients’ information was ensured by the
researcher. As per international standard or
university standard, patient’s written consent has
been collected and preserved by the author(s).
COMPETING INTERESTS
Author has declared that no competing interests
exist.
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© 2021 Iwuoha; This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.

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