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Risk Factors for TB/HIV Coinfection and Consequences for Patient Outcomes: Evidence from 241 Clinics in the Democratic Republic of Congo
Article

Disparities in HIV Clinical Stages Progression of Patients at Outpatient Clinics in Democratic Republic of Congo

1
Division of Global HIV and Tuberculosis, CDC, Atlanta, GA 30329, USA
2
Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA
3
FHI 360, Kinshasa 1015, Democratic Republic of the Congo
4
FHI 360, Washington, DC 20009, USA
5
National AIDS Control Program (PNLS), HIV Program, Ministry of Health, Kinshasa 316, Democratic Republic of the Congo
*
Author to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Int. J. Environ. Res. Public Health 2021, 18(10), 5341; https://doi.org/10.3390/ijerph18105341
Received: 6 April 2021 / Revised: 12 May 2021 / Accepted: 14 May 2021 / Published: 17 May 2021
Context: In this era of patient-centered care, it is increasingly important for HIV/AIDS care and treatment programs to customize their services according to patients’ clinical stage progression and other risk assessments. To enable such customization of HIV care and treatment delivery, the research evidence explaining factors associated with patients’ clinical stages is needed. Objectives: The primary objective of this study was to produce such scientific evidence by analyzing the most recent data for patients at outpatient clinics in the provinces of Kinshasa and Haut-Katanga and to examine the patient characteristics associated with WHO stages of disease progression. Methods: Using a quantitative retrospective cohort study design, we analyzed data from 49,460 people living with HIV (PLHIV) on antiretroviral therapy (ART) from 241 HIV/AIDS clinics located in Haut-Katanga and Kinshasa provinces of the Democratic Republic of Congo. We performed Chi-square and multinomial logistic regression analyses. Results: A small proportion (i.e., 4.4%) of PLHIV were at WHO’s clinical progression stage 4, whereas 30.7% were at clinical stage 3, another 22.9% at stage 2, and the remaining 41.9% were at stage 1, the least severe stage. After controlling for other demographic and clinical factors included in the model, the likelihood of being at stage 1 rather than stage 3 or 4 was significantly higher (at p ≤ 0.05) for patients with no tuberculosis (TB) than those with TB co-infection (adjusted odds ratio or AOR, 5.73; confidence interval or CI, 4.98–6.59). The odds of being at stage 1 were significantly higher for female patients (AOR, 1.35; CI, 1.29–1.42), and those with the shorter duration on ART (vs. greater than 40.37 months). Patents in rural health zones (AOR, 0.32) and semi-rural health zones (AOR, 0.79) were less likely to be at stage 1, compared to patients in urban health zones. Conclusions: Our study showed that TB co-infection raised the risk for PLHIV to be at the severe stages of clinical progression of HIV. Such variation supports the thesis that customized HIV management approaches and clinical regimens may be imperative for this high-risk population. We also found significant variation in HIV clinical progression stages by geographic location and demographic characteristics. Such variation points to the need for more targeted efforts to address the disparities, as the programs attempt to improve the effectiveness of HIV care and treatment. The intersectionality of vulnerabilities from HIV, TB, and COVID-19-related hardships has elevated the need for customized care and treatment even more in the COVID-19 era. View Full-Text
Keywords: HIV clinical stages; TB/HIV co-infection; antiretroviral treatment; multinomial logistic regression; Democratic Republic of Congo HIV clinical stages; TB/HIV co-infection; antiretroviral treatment; multinomial logistic regression; Democratic Republic of Congo
MDPI and ACS Style

Ewetola, R.; Shah, G.H.; Maluantesa, L.; Etheredge, G.; Waterfield, K.; Mulenga, A.; Kilundu, A. Disparities in HIV Clinical Stages Progression of Patients at Outpatient Clinics in Democratic Republic of Congo. Int. J. Environ. Res. Public Health 2021, 18, 5341. https://doi.org/10.3390/ijerph18105341

AMA Style

Ewetola R, Shah GH, Maluantesa L, Etheredge G, Waterfield K, Mulenga A, Kilundu A. Disparities in HIV Clinical Stages Progression of Patients at Outpatient Clinics in Democratic Republic of Congo. International Journal of Environmental Research and Public Health. 2021; 18(10):5341. https://doi.org/10.3390/ijerph18105341

Chicago/Turabian Style

Ewetola, Raimi, Gulzar H. Shah, Lievain Maluantesa, Gina Etheredge, Kristie Waterfield, Astrid Mulenga, and Apolinaire Kilundu. 2021. "Disparities in HIV Clinical Stages Progression of Patients at Outpatient Clinics in Democratic Republic of Congo" International Journal of Environmental Research and Public Health 18, no. 10: 5341. https://doi.org/10.3390/ijerph18105341

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