Prevalence and Risk Factors for Mycobacterium tuberculosis Infection among Health Workers in HIV Treatment Centers in North Central, Nigeria

Evaezi Okpokoro International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria;
Division of Epidemiology and Biostatistics, University of Cape Town, School of Public Health, Cape Town, South Africa;

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Maia Lesosky Division of Epidemiology and Biostatistics, University of Cape Town, School of Public Health, Cape Town, South Africa;

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Chinye Osa-Afiana International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria;

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Florence Bada Vaccine for Africa, University of Cape Town, Institute of Infectious Disease and Molecular Medicine, School of Public Health, Cape Town, South Africa;

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Uzoamaka Okwor International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria;

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George Odonye International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria;

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Victoria Igbinomwanhia International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria;

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Saddiq Abdurrahman Department of Public Health, Federal Capital Territory Administration, Abuja, Nigeria;

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Nubwa Medugu Microbiology, National Hospital Abuja, Abuja, Nigeria;

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Benjamin Kagina Vaccine for Africa, University of Cape Town, Institute of Infectious Disease and Molecular Medicine, School of Public Health, Cape Town, South Africa;

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Alash’le Abimiku International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria;
University of Maryland, School of Medicine, Baltimore, Maryland;

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Shahieda Adams Division of Occupational Medicine, University of Cape Town, School of Public Health, Cape Town, South Africa

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ABSTRACT.

Mycobacterium tuberculosis and HIV constitute a public health challenge. Health workers (HWs) in HIV clinics maybe at greater risk of M. tuberculosis infection, considering the high rates of HIV/tuberculosis (TB) coinfection among patients. Hence, we measured the prevalence of M. tuberculosis infection and the effect of working in an HIV clinic. We conducted a cross-sectional study in high-HIV burden health-care facilities in Abuja and Nasarawa states and recruited HWs over 4 months. We administered questionnaires and screened for M. tuberculosis infection using QuantiFERON-TB Gold-Plus. A total of 1,043 HWs were enrolled, with the majority being clinical staff (77.4%). Prevalence of interferon gamma release assay (IGRA) positivity was 44.8% (43.8% among HWs from HIV clinic and 45.3% from non-HIV clinics, P = 0.24). Nonoccupational factors such as living in a moderately (odds ratio [OR] = 0.71] or sparsely populated neighborhood (OR = 0.56), remained associated with a reduced risk of IGRA positivity, whereas male gender (OR = 1.37) and having high blood pressure (HBP) (OR = 1.52) remained associated with an increased risk after adjusting. Occupational factors such as length of career as a HW of 10 to 20 years (OR = 1.45) or 20 to 30 years (OR = 1.74) remained associated with an increased risk of IGRA positivity after adjusting. In a final multivariate model, the factors of age between 20 to < 30 years (OR = 0.61), having HBP (OR = 1.56), having a length of career as a HW of 10 to 20 years (OR = 1.66) or 20 to 30 years (OR = 2.09) and being a clinical HW (OR = 0.62) remained associated with IGRA positivity. There is a high prevalence of IGRA positivity among HWs in Nigeria. Working in HIV clinics, however, is not associated with increased risk.

Author Notes

Address correspondence to Evaezi Okpokoro, International Research Center of Excellence, Institute of Human Virology Nigeria, Plot 62, Prof. Umaru Shehu Ave., Cadastral Zone C00, Research and Institution Area, Near Baze University, Jabi, Abuja, Nigeria. E-mail: eokpokoro@ihvnigeria.org

Financial support: This study was supported by the EDCTP (Grant no. EDCTP TMA1583CDF2016).

The study was approved by the National Health Research Ethics Committee. Signed informed consent forms were administered prior to enrollment into the study and personal information was kept confidential. All study participants were informed of their QuantiFERON-TB Gold-Plus test result, and further testing and consultation were provided for those who accepted it.

Authors’ addresses: Evaezi Okpokoro, International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria, and Division of Epidemiology and Biostatistics, University of Cape Town, School of Public Health, Cape Town, South Africa, E-mail: eokpokoro@ihvnigeria.org. Maia Lesosky, Division of Epidemiology and Biostatistics, University of Cape Town, School of Public Health, Cape Town, South Africa, E-mail: maia.lesosky@uct.ac.za. Chinye Osa-Afiana, Uzoamaka Okwor, George Odonye, and Victoria Igbinomwanhia, International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria, E-mails: cosaafiana@ihvnigeria.org, oguamauzoamaka@yahoo.com, godonye@gmail.com, and vigbinomwanhia@ihvnigeria.org. Florence Bada and Benjamin Kagina, Vaccine for Africa, University of Cape Town, Institute of Infectious Disease and Molecular Medicine, School of Public Health, Cape Town, South Africa, E-mails: fbada@umaryland.edu and benjamin.kagina@uct.ac.za. Saddiq Abdurrahman, Department of Public Health, Federal Capital Territory Administration, Abuja, Nigeria, E-mail: sadiqabdurrahman5@gmail.com. Nubwa Medugu, Microbiology, National Hospital Abuja, Abuja, Nigeria, E-mail: nubwa.medugu@gmail.com. Alash’le Abimiku, International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria, and University of Maryland, School of Medicine, Baltimore, MD, E-mail: aabimiku@ihv.umaryland.edu. Shahieda Adams, Division of Occupational Medicine, University of Cape Town, School of Public Health, Cape Town, South Africa, E-mail: adams@uct.ac.za.

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