Prevalence of Tuberculosis and Tuman Immunodeficiency Virus Co-infections and Risk Factors among Prisoners in Shimo-la-Tewa Maximum-Security Prison, Mombasa County, Kenya
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Date
2024-10-30
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Kenyatta University
Abstract
Tuberculosis (TB) is one of the leading causes of death due to ‘communicable disease in the world. Despite the WHO recommended TB control strategies to curb the spread, TB burden in prisons is disproportionately higher compared to general population. However, the epidemiological data on TB in prisons from many resource-constrained countries, particularly Kenya, is limited. This study aimed to determine the epidemiology of TB and Human immunodeficiency virus (HIV) co-infections among prisoners (=18 years) presenting with symptoms suggestive of TB at Shimo La Tewa prison health Centre in Mombasa County, Kenya. A descriptive cross-sectional study design was adopted and followed a consecutive sampling technique, excluding patients on current TB treatment or on follow up after completing treatment course in the past 3 months, and those declining to grant study consent. A pretested structured questionnaire was used to collect demographic and clinical characteristics of the participants. Sputum samples (early spot and morning samples) on two consecutive days were collected in clean and sterile 50-ml falcon tubes and kept 2-8°C for analysis within 10 days. Fresh early morning urine samples were collected in a wide-mouth falcon container and held at 2-8°C up to 3 days. Capillary whole blood (20-50 pl) was collected for HIV testing using pipettes after pre- < testing counselling by a qualified nurse. Sputum samples were screened for TB using . fi Xpert MTB/RIF assay and fluorescence microscopy (FM), and urine samples using T Lateral flow urine lipoarabinomannan assay (LF-LAM). HIV virus was screened using Alere DetermineTM and confirmed using HIV-1/2 Ag/Ab First Response® rapid HIV tests, respectively. Data was organized in MS Excel and analyzed using Strata version 17. Analysis on association was done using bivariate and multivariate regression with the statistical significance level at P < 0.05 (95% Confidence Interval). Ethical approval was granted by the Kenyatta University Ethical Review Committee, and all participant provided informed written consent, with an assurance of privacy through anonymity and data coding. TB prevalence among the study participants varied based on the diagnostic technique, highest at 11.5% (18/157) by LF-LAM. HIV prevalence was 19.1% (30/157), while the HIV/TB co-infection rate was 11.5% (18/157), with the highest burden among those aged 30 - 44 years (18/30) and underweight (26/30). The predictive ability of TB LF-LAM for TB diagnosis in comparison to Xpert MTB/RIF assay was 100% sensitivity and 98.6% specificity, with a positive predictive value (PPV) and negative predictive value (NPV) of 88.9% and 100% respectively. Education level, smoking, and use of illegal drugs were independent factors associated with positive TB findings. Participants that had acquired formal education had a 85% less likelihood of having positive TB results in comparison with those haying no formal education, aOR =0.15, 95%CI: 0.04 — 0.50, P=0.002. Respondents with smoking history were four times likely to have positive TB results compared to those who had no such history (aOR = 4.03, 95% CI: 1.17 — 13.96, P =0.028). Those with history of illegal drugs abuse had five times likelihood of having positive TB results compared to those who were not using any illegal drugs (aOR =4.82, 95%CI: 1.02- 22.7, P =0.047). This study recommends a systematic and continuous TB and HIV surveillance. This will inform infection prevention interventions, use of urine LF-LAM as a simple and inexpensive tool for TB in routine active TB case tracing, and TB control programs. The program design will focus on public health education and behavior change, among smokers and illegal drugs users in Shimo La Tewa Maximum Security Prison and beyond.
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Master Thesis
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Citation
Mwatenga, S. A. (2024). Prevalence of tuberculosis and human immunodeficiency virus co-infections and risk factors among prisoners in Shimo-la-Tewa maximum-security prison, Mombasa County, Kenya (Master Thesis, Kenyatta University).