Amare DERIBEW

Thesis summary

Background:

The World Health Organization (WHO) estimates that Ethiopia ranks seventh among the list of 22 high burden countries heavily affected by tuberculosis (TB) and Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS). In this dissertation, we presented the misconceptions and prejudice of the community towards TB/HIV, the burden of TB/HIV and its impact on quality of life (QOL) and mental health.

Methods:

Data for this dissertation were generated from community and multi-facility based cross sectional studies in Oromiya and Addis Ababa regional states in Ethiopia.  In a community-based survey in Southwest Ethiopia (paper I and III), we determined the prevalence of pulmonary TB and HIV infection among TB suspects; and the misconception and prejudice of the community towards people living with HIV/AIDS and TB patients. The prevalence of TB and HIV among TB suspects was also assessed in 27 health facilities in Addis Ababa, the capital city of Ethiopia (paper II). The uptake of provider-initiated HIV counseling and testing (PICT) among TB suspects was assessed in Addis Ababa (Paper IV). The effect of TB/HIV co-infection on QOL and mental health was assessed in three hospitals in Oromiya regional state (paper V and VI).

Results:

The prevalence of pulmonary TB in the rural community of Southwest Ethiopia (76.1/100,000) was low compared to other findings. However, there were 4.3 undiagnosed infectious TB cases in the community for each TB patient diagnosed at the health facility. On the other hand, the prevalence of pulmonary TB among TB suspects in Addis Ababa (21.3%) was very high. The prevalence of HIV among TB suspects in rural community and Addis Ababa was 5.5% and 27% respectively. Majority of the community have misconception on the modes of transmission of HIV and TB. HIV/AIDS and TB are highly stigmatized diseases in the community affecting the social relationship of individuals. Significant proportion of the TB suspects did not seek help for their ill health. Traditional healers and local herbs are the first treatment options for TB suspects.

The uptake of PICT among TB suspects was low in Addis Ababa. Poor awareness on PICT and HIV/AIDS, previous experience of PICT and employment were the best predictors of uptake of PICT.

TB/HIV co-infection was negatively associated with all the domains of QOL. Common mental disorders (CMD) were more common among TB/HIV co-infected patients than HIV-positive individuals without TB.

Conclusion and Recommendation:

There was a large discrepancy of prevalence of TB among TB suspects in rural and urban areas. Despite the low prevalence of pulmonary TB in the rural community, there were significant undiagnosed infectious cases that could transmit the disease in the rural settings. The widespread misconception, stigma and poor health care seeking behavior could be the serious bottlenecks for the TB/HIV control program to achieve the TB and HIV related Millennium Development Goals (MDG). The low uptake of PICT is also a challenge to achieve the STOP TB strategy target of HIV testing of 100% of TB patients by 2015. TB/HIV co-infection has major impact on the QOL and mental health of individuals.

The Ethiopian national TB control program should design a strategy to improve case detection rate by providing tailored health education messages through mass media and involvement of lower health cadres at the grassroots level.  The TB/HIV control programs in collaboration with other partners should invest more in social mobilization and education of rural communities to address the predictors of PICT and rectify the widespread prejudice and low awareness about TB and HIV/AIDS. The ministry of health (MOH) should develop guideline and policy to improve the QOL of TB/HIV-co-infected patients and to identify and timely treat CMD in these patients.