{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T18:39:47Z","timestamp":1772217587670,"version":"3.50.1"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T00:00:00Z","timestamp":1695254400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\n Background<\/jats:title>\n Tuberculosis is the leading cause of morbidity and mortality among children living with the human immunodeficiency virus (HIV), mainly in sub-Saharan Africa, including Ethiopia. Tuberculosis remains a significant health concern for HIV-positive children in Ethiopia. There is a paucity of data on the incidence and predictors of tuberculosis among children living with HIV on antiretroviral therapy in the Wolaita zone. Hence, this study aimed to assess the incidence and predictors of tuberculosis among children living with HIV on antiretroviral therapy in the Wolaita zone between January 2010 to December 2020.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective cohort study was conducted among 389 children receiving antiretroviral therapy in Wolaita zone health facilities between January 2010 to December 2020. The checklist was adapted from the standardized antiretroviral treatment (ART) follow-up form currently used by the institutions\u2019 ART clinics. The Kaplan-Meier survival function and Log-rank were used to estimate the survival for each categorical variable to compare the survival between different exposure groups. Both bivariable and multivariable parametric survival Gompertz models were fitted to identify predictors of tuberculosis among HIV-positive children. The association was summarized using an adjusted hazard ratio (AHR), and statistical significance was declared at 95% CI and p-value < 0.05. The goodness of the model fit was assessed using a Cox-Snell residual plot.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The incidence rate of tuberculosis among children living with HIV was 3.5 (95% CI 2.7\u20134.5) per 100 child years. World Health Organization clinical stage III or IV (AHR = 2.31, 95% CI [1.26, 4.22]), hemoglobin level <10 g\/dL (AHR = 2.87, 95% CI [1.51, 5.45]), fair or poor ART adherence (AHR = 4.4, 95% CI[2.18, 9.05]), underweight (AHR = 2.55, 95% CI [1.45, 4.51]), age >10 years (AHR = 3.62; 95% CI [1.29, 10.0]), and cotrimoxazole preventive therapy (AHR = 0.23; 95% CI [0.08, 0.60]) were among the independent predictors of TB occurrence.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The incidence of tuberculosis among children on ART was high. HIV-positive children presenting with advanced disease staging (III and IV), anemia, \u201cfair\u201d and \u201cpoor\u201d ART adherence, underweight, age above ten years, and not receiving cotrimoxazole preventive therapy were at higher risk of TB. Therefore, counseling on ART adherence, early diagnosis, and prompt treatment of anemia and malnutrition are recommended to avert tuberculosis.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0291502","type":"journal-article","created":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T13:29:17Z","timestamp":1695302957000},"page":"e0291502","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Incidence and predictors of tuberculosis among children receiving antiretroviral therapy in the Wolaita Zone: A retrospective cohort study"],"prefix":"10.1371","volume":"18","author":[{"given":"Daneil","family":"Tekese","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2006-6368","authenticated-orcid":true,"given":"Desalegn","family":"Dawit","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Behailu","family":"Hawulte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3920-2625","authenticated-orcid":true,"given":"Hussein","family":"Mohammed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fekede","family":"Asefa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lemessa","family":"Oljira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,9,21]]},"reference":[{"key":"pone.0291502.ref001","unstructured":"WHO. World Health Organization: Tuberculosis. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/tuberculosis. Accessed June 11, 2021 2020."},{"key":"pone.0291502.ref002","volume-title":"Global tuberculosis report.","author":"WHO","year":"2022"},{"key":"pone.0291502.ref003","doi-asserted-by":"crossref","first-page":"634489","DOI":"10.3389\/fimmu.2021.634489","article-title":"Persistent T Cell Repertoire Perturbation and T Cell Activation in HIV After Long Term Treatment.","volume":"12","author":"CT Turner","year":"2021","journal-title":"Front Immunol"},{"key":"pone.0291502.ref004","first-page":"48","article-title":"Childhood tuberculosis treatment outcome and its association with HIV co-infection in Ethiopia: a systematic review and meta-analysis","author":"GM Belay","year":"2020","journal-title":"Trop Med Health"},{"issue":"6","key":"pone.0291502.ref005","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1136\/thoraxjnl-2016-209421","article-title":"The impact of HIV and antiretroviral therapy on TB risk in children: a systematic review and meta-analysis.","volume":"72","author":"PJ Dodd","year":"2017","journal-title":"Thorax"},{"issue":"1","key":"pone.0291502.ref006","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s12879-020-4772-y","article-title":"Incidence of common opportunistic infections among HIV-infected children on ART at Debre Markos referral hospital, Northwest Ethiopia: a retrospective cohort study.","volume":"20","author":"MW Melkamu","year":"2020","journal-title":"BMC Infectious Diseases"},{"issue":"1","key":"pone.0291502.ref007","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1186\/s13104-018-3846-z","article-title":"Incidence of tuberculosis in children on antiretroviral therapy: a retrospective cohort study.","volume":"11","author":"A Endalamaw","year":"2018","journal-title":"BMC Res Notes"},{"issue":"5","key":"pone.0291502.ref008","first-page":"653","article-title":"How Far Does Highly Active Antiretroviral Treatment Reduce TB Incidence among Children? A Marginal Structural Modeling Analysis, Southwest Ethiopia.","volume":"30","author":"F Tiruneh","year":"2020","journal-title":"Ethiop J Health Sci"},{"issue":"4","key":"pone.0291502.ref009","doi-asserted-by":"crossref","first-page":"e0152941","DOI":"10.1371\/journal.pone.0152941","article-title":"High Incidence of Tuberculosis in the Absence of Isoniazid and Cotrimoxazole Preventive Therapy in Children Living with HIV in Northern Ethiopia: A Retrospective Follow-Up Study.","volume":"11","author":"YM Alemu","year":"2016","journal-title":"PloS one"},{"key":"pone.0291502.ref010","doi-asserted-by":"crossref","first-page":"e2019028","DOI":"10.4178\/epih.e2019028","article-title":"Incidence and predictors of tuberculosis among HIV-positive children at Adama Referral Hospital and Medical College, Oromia, Ethiopia: a retrospective follow-up study.","volume":"41","author":"MT Beshir","year":"2019","journal-title":"Epidemiol Health."},{"key":"pone.0291502.ref011","article-title":"Incidence of Tuberculosis and Associated Mortality in a Cohort of Human Immunodeficiency Virus-Infected Children Initiating Antiretroviral Therapy.","author":"N N-G-HN Salvadori","year":"2017","journal-title":"Journal of the Pediatric Infectious Diseases Society"},{"issue":"3","key":"pone.0291502.ref012","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1093\/trstmh\/trv108","article-title":"The WHO\u2019s new End TB Strategy in the post-2015 era of the Sustainable Development Goals","volume":"110","author":"K L\u00f6nnroth","year":"2016","journal-title":"Transactions of the Royal Society of Tropical Medicine and Hygiene"},{"issue":"1","key":"pone.0291502.ref013","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1186\/s12879-019-4031-2","article-title":"The protective effect of isoniazid preventive therapy on tuberculosis incidence among HIV positive patients receiving ART in Ethiopian settings: a meta-analysis.","volume":"19","author":"D Geremew","year":"2019","journal-title":"BMC infectious diseases"},{"issue":"3","key":"pone.0291502.ref014","article-title":"Isoniazid Preventive Therapy Uptake and Completion Among Hiv Infected Children In Two Referral Hospitals, Northwest Ethiopia.","volume":"56","author":"W Belaynew","year":"2018","journal-title":"Ethiop Med J."},{"key":"pone.0291502.ref015","article-title":"Effect of Isoniazid Preventive Therapy on the Incidence of Tuberculosis among Seropositive Children Attending HIV\/AIDS Care in Two General Hospitals, Northwest Ethiopia, 2021","author":"F Kebede","year":"2021","journal-title":"Journal of Tropical Medicine"},{"key":"pone.0291502.ref016","doi-asserted-by":"crossref","first-page":"307810","DOI":"10.1155\/2015\/307810","article-title":"Incidence and Predictors of Tuberculosis among HIV Positive Children at University of Gondar Referral Hospital, Northwest Ethiopia: A Retrospective Follow-Up Study.","volume":"2015","author":"SG Ayalaw","year":"2015","journal-title":"International scholarly research notices."},{"key":"pone.0291502.ref017","volume-title":"Guidelines for Paediatric HIV\/AIDS Care and Treatment in Ethiopia.","author":"FMoH","year":"2007"},{"issue":"5","key":"pone.0291502.ref018","article-title":"Survival and predictors of mortality amongchildren co-infected with tuberculosis and human immunodeficiency virus at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.","volume":"13","author":"AA Kendalem","year":"2018","journal-title":"PLoS ONE."},{"issue":"2","key":"pone.0291502.ref019","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/MPG.0b013e318298003f","article-title":"World Health Organization 2006 child growth standards and 2007 growth reference charts: A discussion paper by the committee on Nutrition of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.","volume":"57","author":"D Turck","year":"2013","journal-title":"Journal of pediatric gastroenterology and nutrition."},{"key":"pone.0291502.ref020","article-title":"Antiretroviral therapy for HIV infection in infants and children: Towards universal access recommendations for a public health approach.","author":"WHO","year":"2010","journal-title":"HIV\/AIDS programme"},{"issue":"8","key":"pone.0291502.ref021","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1097\/QAD.0b013e32835ecb24","article-title":"Incident tuberculosis and risk factors among HIV-infected children in Tanzania","volume":"27","author":"N Li","year":"2013","journal-title":"AIDS"},{"key":"pone.0291502.ref022","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s12916-016-0593-7","article-title":"Tuberculosis incidence is high in HIV-infected African children but is reduced by co-trimoxazole and time on antiretroviral therapy","volume":"14","author":"AM Crook","year":"2016","journal-title":"BMC medicine"},{"issue":"11","key":"pone.0291502.ref023","article-title":"Tuberculosis IRIS: Pathogenesis, Presentation, and Management across the Spectrum of Disease.","volume":"10","author":"CM Quinn","year":"2020","journal-title":"Life (Basel, Switzerland)."},{"issue":"5","key":"pone.0291502.ref024","doi-asserted-by":"crossref","first-page":"313","DOI":"10.7326\/0003-4819-157-5-201209040-00004","article-title":"The immune reconstitution inflammatory syndrome after antiretroviral therapy initiation in patients with tuberculosis: findings from the SAPiT trial","volume":"157","author":"K Naidoo","year":"2012","journal-title":"Annals of internal medicine"},{"issue":"6","key":"pone.0291502.ref025","doi-asserted-by":"crossref","first-page":"e0253449","DOI":"10.1371\/journal.pone.0253449","article-title":"Incidence and predictors of mortality among children co-infected with tuberculosis and human immunodeficiency virus at public hospitals in Southern Ethiopia.","volume":"16","author":"Z Dawit","year":"2021","journal-title":"PLOS ONE"},{"issue":"3","key":"pone.0291502.ref026","doi-asserted-by":"crossref","first-page":"220","DOI":"10.4103\/1947-2714.109196","article-title":"Adherence to antiretroviral therapy among people living with HIV","volume":"5","author":"B Achappa","year":"2013","journal-title":"North American Journal of Medical Sciences"},{"issue":"282","key":"pone.0291502.ref027","article-title":"Predictors of pediatric tuberculosis in public health facilities of Bale zone, Oromia region, Ethiopia: a case control study.","volume":"18","author":"B Gebremichael","year":"2018","journal-title":"BMC Infectious Diseases"},{"issue":"3","key":"pone.0291502.ref028","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1007\/s15010-015-0851-1","article-title":"Treatment of Pneumocystis pneumonia with intermediate-dose and step-down to low-dose trimethoprim-sulfamethoxazole: lessons from an observational cohort study.","volume":"44","author":"D Creemers-Schild","year":"2016","journal-title":"Infection."},{"issue":"3","key":"pone.0291502.ref029","first-page":"159","article-title":"Pneumocystis Pneumonia: Still a serious disease in children","volume":"23","author":"M Zakrzewska","year":"2021","journal-title":"Journal of mother and child"},{"issue":"8","key":"pone.0291502.ref030","first-page":"e27746","article-title":"Tuberculosis-Associated Anemia: A Narrative Review.","volume":"14","author":"T Dasaradhan","year":"2022","journal-title":"Cureus"},{"issue":"3","key":"pone.0291502.ref031","doi-asserted-by":"crossref","DOI":"10.3390\/microorganisms11030785","article-title":"Iron Status and Supplementation during Tuberculosis.","volume":"11","author":"A Nienaber","year":"2023","journal-title":"Microorganisms"},{"issue":"6","key":"pone.0291502.ref032","doi-asserted-by":"crossref","first-page":"436","DOI":"10.2174\/1389450120666190214144609","article-title":"Antiretroviral Therapy-associated Adverse Drug Reactions and their Effects on Virologic Failure- A Retrospective Cohort Study in Nigeria.","volume":"16","author":"IO Abah","year":"2018","journal-title":"Curr HIV Res."},{"key":"pone.0291502.ref033","volume-title":"Nutrition and HIV\/AIDS.","author":"KS Vangal","year":"2020"},{"issue":"4","key":"pone.0291502.ref034","article-title":"Role of nutrition in HIV infection: review of evidence for more effective programming in resource-limited settings.","volume":"31","author":"S de Pee","year":"2010","journal-title":"Food and nutrition bulletin."},{"issue":"1","key":"pone.0291502.ref035","doi-asserted-by":"crossref","first-page":"9","DOI":"10.4103\/0970-2113.45198","article-title":"Tuberculosis and nutrition","volume":"26","author":"KB Gupta","year":"2009","journal-title":"Lung India"},{"issue":"1","key":"pone.0291502.ref036","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1089\/aid.2016.0261","article-title":"Malnutrition in HIV-Infected Children Is an Indicator of Severe Disease with an Impaired Response to Antiretroviral Therapy","volume":"34","author":"M Muenchhoff","year":"2018","journal-title":"AIDS Res Hum Retroviruses"},{"key":"pone.0291502.ref037","doi-asserted-by":"crossref","first-page":"26","DOI":"10.11604\/pamj.2014.17.26.2641","article-title":"Perceived barriers to the implementation of Isoniazid preventive therapy for people living with HIV in resource constrained settings: a qualitative study.","volume":"17","author":"M Mindachew","year":"2014","journal-title":"Pan Afr Med J."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0291502","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T13:29:36Z","timestamp":1695302976000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0291502"}},"subtitle":[],"editor":[{"given":"Mohammed Feyisso","family":"Shaka","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,9,21]]},"references-count":37,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0291502","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.742785027.793601133","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,21]]}}}