102 © Adama Science & Technology University https://ejssd.astu.edu.et Ethiopian Journal of Science and Sustainable Development (EJSSD) p-ISSN 1998-0531 Volume 5 (1), 2018 Prevalence of Human Immunodeficiency Virus among Tuberculosis Patients Visiting Metehara Sugar Factory Hospital, Oromia Regional State: a Five-year Retrospective Study Bizuayehu Mekuria1 and Daniel Getahun Debelo1* 1 Adama Science and Technology University School of Applied Natural Sciences: Applied Biology Program. *Corresponding author, E-mail: daniel.debelo@astu.edu.net Abstract Tuberculosis is the leading cause of death for HIV-infected patients, and HIV is the most important risk factor for developing active TB. The risk of death from TB is significantly higher in the HIV-infected population. The interaction between TB - HIV co-infected person is bidirectional and synergistic: HIV infection predisposes to the development of active TB, and the course of HIV-related immunodeficiency is worsened by active TB infection. The aim of this five-year retrospective study was to assess the prevalence of TB - HIV co-infections among patients who visited Metehara Sugar Factory Hospital (MSFH) from March 2012 to April 2017. In total 1165 TB patients visited MSFH from March 2012 to April 2017 and of these 1028 (88 %) who had a documented HIV test results were included in the study. Data were collected from medical records of all TB patients who were on anti- tuberculosis treatment during the aforementioned period. About 21 % of them were found HIV-positive. The percentage of TB/HIV co-infection was higher in females than males, single than married individuals, unemployed than employed and active working force than other age groups. The ART coverage of the TB/HIV co-infected patients was 78 % which was lower than WHO target of 100 %. Interventions to prevent HIV transmission among TB patients include counseling for patients and preventive intervention programs that attempt to change high-risk behavior. Keywords: Co-infection, HIV/AIDS, Metehara, prevalence, retrospective, Tuberculosis 1. Introduction Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis which is also known as Tubercle bacilli. Tuberculosis is one of the major global health problems, which ranked as the second leading cause of death from an infectious disease Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 103 © Adama Science & Technology University https://ejssd.astu.edu.et worldwide next to human immunodeficiency virus (HIV) that causes ill health among millions of people each year (WHO, 2012). Human Immunodeficiency Virus (HIV) and Tuberculosis are closely associated where HIV promotes the progression from latent infection to active disease and TB is the leading infectious killer of people living with HIV (Lata et al., 2015). Infection with HIV is an established risk factor for acquiring and developing infection with tuberculosis, and the recent increase in the worldwide prevalence of HIV infection has contributed to the rising global incidence of TB (Abera et al., 2009). Tuberculosis is one of the most common infections that threaten people living with HIV (PLWHIV) in the developing world and together with HIV; TB is responsible for the deaths of over 4 million people annually (RESULTS Canada, 2010). Globally the most TB cases are in Asia, the highest incidence rates are in sub-Saharan Africa where high rates of HIV and malnutrition weaken immune systems and accelerate the spread of the disease. Consequently, the number of new TB cases in most African countries has more than quadrupled since 1990, with 2.8 million new TB cases and roughly 735 thousand deaths annually (Fekadu et al., 2015). Tuberculosis is a common opportunistic infection in sub-Saharan Africa. Thus, the countries in the sub- region continue taking the leading position in HIV/TB morbidity and mortality rate, where the TB epidemic was primarily driven by HIV infection (Hailu and Eshetu, 2013). Tuberculosis has been recognized as a major public health problem for more than five Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 104 © Adama Science & Technology University https://ejssd.astu.edu.et decades in Ethiopia. Ethiopia is one of the 22 high burden countries (HBCs) and TB remains one of the leading causes of mortality. According to the WHO (2014), the prevalence and incidence of all forms of TB are 211 and 224 per 100,000 of the population, respectively. About 13% of all new TB cases are also HIV co-infected. Moreover, Ethiopia is one of the high TB/HIV and multidrug resistant TB (MDR TB) burden countries. Among TB patients with known HIV status, about 11% were HIV co-infected (Mulugeta and Alemu, 2016). According to the Ethiopian Ministry of Health hospital statistics data, tuberculosis is the leading cause of morbidity, the third cause of hospital admission (after deliveries and malaria) and the second cause of death in Ethiopia after malaria (EFMoH, 2008). Since 2002, Ethiopia has been implementing the TB/HIV collaborative activities (EFMoH, 2009). However, only few studies reported that HIV co-infection has been a major public health challenge among TB patients of the country (Sebsibe and Takele, 2013). Assessment about HIV co- infection among TB patients might help to understand the spread of the co-infections and to monitor the performances of TB and HIV sustainable controlling and monitoring activities (WHO, 2012). Understanding the predictors of TB/HIV co-infections in the local context is critical for Ethiopia to improve co-management of TB/HIV co-infected patients (Mitiku et al., 2016). The prevalence of TB infection is significantly associated with the incidence of HIV and vice versa across the areas in Oromia region. Assessment of the prevalence of TB among HIV patients and vice Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 105 © Adama Science & Technology University https://ejssd.astu.edu.et versa is increasingly seen as important, as the HIV epidemic has continued to fuel the TB disease (Abera et al., 2009). Metahara Sugar Factory has a large number of workers and the workers have access to free treatment in the factory’s hospital. The hospital provides services for over 2800 patients per year. The prevalence of HIV among TB positive individuals at Metehara Sugar Factory hospital has not been studied. Knowledge of the prevalence of HIV positive cases among TB patients is important for better program planning HIV testing for all TB patients in order to design HIV/AIDS management program in an effort to stop the continued transmission of HIV within the community. Therefore, this retrospective study was to investigate the prevalence and trends of HIV-positive individuals among TB patients (TB/HIV co- infections). 2. MATERIAL AND METHODS 2.1 Description of the Study Area This study was carried out in Metehara Sugar Factory (MSF) in Fentalle district, East Shoa Zone of Oromia Regional State. The factory is bounded by escarpments from east, west and south. It is located at 8o50'N latitude and 39o50'E longitude and the elevation is 950 m above sea level (Fig. 1). It is found at a distance of 200 km southeast of Addis Ababa within upper Awash Valley, near the main road to Harar. The area is typically characterized by semi- arid climate with a mean relative humidity of 55.4 %, average annual rainfall of 543 mm, mean minimum and maximum temperatures of 17.2OC and 32OC, respectively (Metehara Sugar Research Metrological Center, unpublished data). Metehara Sugar Factory Hospital provides services for over Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 106 © Adama Science & Technology University https://ejssd.astu.edu.et 2800 patients per year. There were 4 doctors, 3 health officers, 30 nurses, 8 health extension workers,5 laboratory technicians, 1 radiologist, 2 HIV and Anti HIV drug treatment nurses, 2 data encoders and case managers. The clinics provide basic health services entirely based on clinical symptoms within the respective villages and communities including from nearby Afar and Somali districts. However, laboratory based medical treatment for TB and HIV is provided only in the hospital. Figure 1: Map of the study area (Source: Ethio Arc GIS, 2017) 2.2 Study population and study design The design of this study was a five-year retrospective descriptive survey of the prevalence of TB and TB/HIV co-infections among patients who visited MSFH from March 2012 to April 2017. In total 1165 TB patients visited MSFH and of these 1028 (88.2 %) who were registered and treated according to the clinical guidelines of the National Tuberculosis and Leprosy Control Program Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 107 © Adama Science & Technology University https://ejssd.astu.edu.et (NTLCP) (EFMoH, 2008) and had a documented HIV test results were included in the study. 2.3 Variables The response variable for this study is the occurrence of TB/HIV co-infection. The predictor variables are socio-demographic characteristics (age, sex, occupation) and clinical related characteristics (ART status, TB type, and Treatment outcomes) of the patients. 2.4 Data Analysis Collected data were checked for missing values, organized, coded, tabulated and then were analyzed using descriptive statistics with Excel Microsoft ware computer. Descriptive statistics (frequencies and summary statistics (percentage) were used to describe patients' characteristics. 2.5 Ethical Consideration Ethical clearance was obtained from Health Research Ethical Review Committee of Oromia Regional Health Bureau. Before conducting the study, the purpose and importance of the study was explained to the MSF management, DOTS-HIV care unit officials and participants of the study. Confidentiality and anonymity of the data from the hospital’s documents and interviewees were secured by using codes throughout the study. 3. RESULTS 3.1. Socio-demographic characteristics Of the total (1028) TB patients attended the hospital, male patients account for 56 % of the study subjects. Most (60.4 %) of the patients were found in the age group 25 – 34 years and about 51 % (n = 521) were married, 32.5% were employed (Table 1). 3.2 Clinical characteristics of TB patients Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 108 © Adama Science & Technology University https://ejssd.astu.edu.et Type of TB, HIV status, ART status, and treatment outcome of patients are depicted in Table 2. About 80 % (n = 817) of the TB patients had pulmonary TB type and of the total patients about 66 % had smear negative pulmonary TB type. About 21 % (n = 211) of the total TB patients visited the hospital were found to be HIV- positive, about 65 % completed treatment, 13.3 % (n = 137) were cured and 4.5 % (n = 46) of them died. About 79 % of the TB/HIV co-infected patients had been following anti-retroviral therapy (ART). Table 1. Socio-demographic characteristics of TB patients at Metehara Sugar Factory Hospital from March 2012 to April 2017 (N =1028) Variables Number Percentage (%) Sex Male Female 575 453 55.9 44.1 Age (years) 0-14 15 -24 25 - 34 35 - 44 45 - 54 >54 60 152 628 99 76 13 5.8 11.0 60.4 14.0 7.5 1.3 Residence Inside MSF Outside MSF 382 646 38.1 61.9 Occupational status Employed Housewife Unemployed Farmer/pastoralist Others 334 166 156 78 294 32.5 16.1 15.2 7.6 28.6 Marital status Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 109 © Adama Science & Technology University https://ejssd.astu.edu.et Note: Others = students, merchants, preschool children, pensioners, commercial sex workers Table 2: Clinical characteristics of TB patients visited Metehara Sugar Factory Hospital from March 2012 to April 2017 (N = 1028) Characteristics Number Percentage Type of TB SPPTB SNPTB EPTB 143 674 211 13.9 65.6 20.5 HIV status Positive Negative 218 810 21.2 78.8 ART status (N = 218) Pre ART On ART 48 170 22.0 78.0 Treatment outcome Completed Cured Transfer out Defaulter Failure Dead Treatment success 664 137 28 109 44 46 801 64.6 13.3 2.7 10.6 4.3 4.5 77.9 Note: SPPTB = Smear Positive Pulmonary TB; SNPTB = Smear Negative Pulmonary TB; EPTB = Extra Pulmonary TB; ART = Anti Retroviral Therapy Married Single Widowed Divorced Children/undecided 521 299 39 22 147 50.7 29.1 3.8 2.1 14.3 Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 110 © Adama Science & Technology University https://ejssd.astu.edu.et 3.3. Prevalence of TB-HIV co- infection by age group of the study participants Prevalence of TB/HIV co- infection of patients by age group and sex is shown in (Table 3). About 21 % (n = 218) of the total TB patients visited the hospital were found to be HIV positive (TB/HIV co-infection). The percentage of female TB/HIV co- infected female patients was generally higher than that of males and the highest percentage (28.3 %) of HIV positive TB patients were in the age group 15 - 24 years both sexes considered together. 3.4 Prevalence of TB/HIV co- infection by marital status and sex The percentage of HIV status of TB patients of unmarried males was about two-fold (26.0 %) than married ones (13.4 %) while that of single females was about 3.4 times than HIV positive married females. When HIV status of single and married TB patients of both sexes is seen, 35 % of single TB patients were HIV positive while only 15 % of the married TB patients were HIV positive (Table 4). 3.5 Prevalence of TB/HIV co- infection by occupational status of the patients Most (51.3 %) of the 218 TB/HIV co-infected patients were unemployed and the percentage of females was higher than that of the males (Table 5). 3.6 Trend of TB/HIV co-infection among TB Patients There was a slight decrease of TB/HIV trend from 2012 to 2015 but it increased from 2015 to 2017 Fig. 2). Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 111 © Adama Science & Technology University https://ejssd.astu.edu.et Table 3: Prevalence of TB/HIV co-infection of patients by age group and sex visited Meteha Sugar Factory Hospital from March 2012 to April 2017 (N = 1028) Table 4: Prevalence of HIV infection among TB patients by their marital status and sex at Metehara Sugar Factory Hospital from March 2012 to April 2017 (N = 218) Male Female Both sexes Age (years) Number examined Number positive (%) Number examined Number positive (%) Number examined Number positive (%) 0 -14 15 - 24 25 - 34 35 - 44 45 – 54 > 54 31 93 354 53 36 8 3 (10) 19 (20.4) 68 (19.2) 5 (9.4) 2 (5.6) 1(13) 29 59 274 46 40 5 6 (21) 24 (41) 69 (25.2) 15 (33) 6 (15) 0 (0) 60 152 628 99 76 13 9 (15) 43 (28.3) 137 (21.8) 20 (20.2) 8 (11) 1 (8) Total 575 98 (17) 453 120 (26.5) 1028 218 (21.2) Male Female Both sexes Marital status Number examined Number positive (%) Number examined Number positive (%) Number examined Number positive (%) Married Single Widowed Divorced Children 262 208 8 10 87 35 (13.4) 54 (26.0) 0 (0) 1 (10) 8 (9.2) 259 91 31 12 60 43 (16.6) 51 (56.0) 6 (19.4) 5 (41.7) 15 (25) 521 299 39 22 147 78 (15.0) 105 (35.1) 6 (15.4) 6 (27.3) 23 (15.6) Total 575 98 (17) 453 120 (26.5) 1028 218 (21.2) Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 112 © Adama Science & Technology University https://ejssd.astu.edu.et Table 5: Prevalence of HIV infection among TB patients by occupational status and sex at Metehara Sugar Factory Hospital from March 2012 to April 2017 (N = 1028) Occupational status Male Female Both sexes Occupational status Number examine d Number positive (%) Number examine d Number Positive (%) Number examine d Number Positive (%) Employed House wife Unemployed Farmer/pastoralist Others 234 - 96 71 174 28 (12.0) - 46 (48.0) 14 (20.0) 10 (6.0) 100 166 60 7 120 31 (31.0) 21 (15.0) 34 (57.0) 0 (0.0) 31 (26.0) 334 166 156 78 294 59 (18.0) 24 (14.5) 80 (51.3) 14 (18.0) 41 (14.0) Total 575 98 (17) 453 120 (26.5) 1028 218 (21.2) Note: Others = students, merchants, preschool children, pensioners, commercial sex workers. Fig. 2: Trend of TB and TB-HIV co-infection at Metehara Sugar Factory Hospital from March 2012 to April 2017 Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 113 © Adama Science & Technology University https://ejssd.astu.edu.et 3. Discussion This study showed that TB occurs in all age groups. Of the total (N = 1028) TB patients attended the hospital, male patients account for 56 % of the study subjects and this in line with Derek et al. (2015) who reported that tuberculosis cases are more prevalent among men than women, and TB mainly affects adults in their productive years. Of the different factors, gender difference is one of the risk factors which may indirectly influence the male-to-female ratio of tuberculosis. In high-burden countries, smoking is much more frequent in men than in women, and a correlative analysis of cigarette smoking, sex, and tuberculosis suggests that smoking might explain up to one-third of the gender bias observed in this setting. Alcohol consumption is also a risk factor for tuberculosis, and the prevalence in low-income countries among men is much higher than that among women (Watkins and Plant, 2006). Of the total TB patients, about 21 % (n = 218) of them were found HIV-positive. Results of similar studies conducted on the HIV prevalence rate among TB patients show variations. The HIV prevalence rate in the present study is similar to some of these studies. In Amhara Regional State, Tarekegn Daniel et al. (2016) recorded about 20 % TB/HIV co- infection at Metema Hospital from 2009-2012 and Amare (2015) reported about 22 % in a study conducted from 2009-2014 at Fenote Selam District Hospital. However, Adisu et al. (2016) reported a lower percentage of about 13 % in a study conducted from 2008 to 2013 at Debretabor Hospital, while a higher percentage (31 %) was reported by Lengisa et al. (2015) and 44.8 % at Debre Markos Referral Hospital, Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 114 © Adama Science & Technology University https://ejssd.astu.edu.et Amhara Regional State (Ahmed et al., 2013). Infection by M. tuberculosis exacerbates HIV infection. The incidence and mortality rates for new AIDS-defining opportunistic infections have been shown to be higher if individuals with HIV are co-infected with TB (Pawlowski et al., 2012). Generally, a relatively small proportion of people infected with M. tuberculosis will develop active TB disease. However, those with HIV have a much higher chance of developing the active disease. The burden of TB continues to increase due to poverty, population growth, and HIV/AIDS (Derek et al., 2015). The results of this study showed that the proportion of TB/HIV co-infection was higher in females (26.5 %) than in males (17 %). Some similar studies conducted in Ethiopia showed even very high TB/HIV co- infection in females than in males. Damtew et al. (2013) reported 37 % in Bishoftu Hospital and Jemberu et al. (2017) reported 76.3 % of TB/HIV co-infection in females in Gambella Regional State Hospital. Higher infection in females is attributed to permanent immune suppression associated with pregnancy and more likely lowered immunity due to the stress as a result of their biological, economic and cultural roles as household care-givers (Ahmed et al., 2013). Women are more affected by HIV/AIDS than males because of their difference in their socio-economic, political, legal and cultural status, as well as biology (Jackson, 2002). The higher prevalence of TB/HIV co- infection in female than males is expected due to the fact that HIV has more chance of transmission from males to females than from females to males. In line with this Georgina et al. (2013) reported that the penile-vaginal Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 115 © Adama Science & Technology University https://ejssd.astu.edu.et transmission by an infected individual in a single sexual exposure is as low as one in 1000 from female to male and as high as one in 300 from male to female (Georgina et al., 2013). Over 60 % (n = 628) of the TB patients were found within age group of 25 – 34 years and they constitute the highest (28 %) HIV positive, followed by 25 - 34 (21.8 %) and 35 - 44 (20.2 %) age groups in order. People in these age groups are more active for sexual activity and they are vulnerable to TB and HIV risk behaviors such as substance use and unprotected sexual practices than any other part of the population. The high co-infection prevalence among these age groups which comprises a large part of workforce and productive section of the society might face grave consequences of poverty that aggravate in acquiring the infections. These age groups, being parents of young children, could also be heavily contributing to spread of TB in the household (EHNRI, 2011). Similar studies at Bishoftu Hospital (Damtew et al., 2013), Metema Hospital (Tarekegn Daniel et al., 2016) and Debre Markos referral Hospital (Amare, 2015) also reported highest HIV infected TB patients within age group of 25 - 34 years. The current study indicated that higher percentage (35 %) of unmarried TB patients was co- infected with HIV than married (15 %) TB patients. The percentage of single female (56 %) HIV-positive was over two-folds HIV- positive single males (26 %). This may indicate that the single individuals practiced multiple sexual partners than the married ones which is one of the risk factors for contracting HIV. There was also variation in the prevalence of TB/HIV co- infection in relation to Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 116 © Adama Science & Technology University https://ejssd.astu.edu.et occupational status. The rate of TB/HIV co-infection was higher among unemployed (51%) than employed (18 %) ones. High rates of unemployment lead to behaviors that increase the risks of tuberculosis and HIV infections such as alcohol consumption, smoking, intravenous drug use and unprotected sex (Azukie et al., 2014; Przybylski et al., 2014). Sharma et al. (2005) also reported that TB/HIV co-infection is intricately linked to unemployment that resulted in poverty and homelessness which may result in malnutrition, drug side effect and low stamina among patients and may possibly lead to poor adherence, death or discontinuation of anti TB chemotherapy. Mycobacterium tuberculosis– HIV co-infections pose particular diagnostic and therapeutic challenges and exert immense pressure on health care systems in African and Asian countries with large populations of co-infected individuals (Pawlowski et al., 2012). Tuberculosis is the leading cause of death for HIV-infected patients, and HIV is the most important risk factor for developing active TB. The risk of death from TB is significantly higher in the HIV-infected population. The interaction between TB - HIV co-infection is bidirectional and synergistic: HIV infection predisposes to the development of active TB, and the course of HIV-related immunodeficiency is worsened by active TB infection (Amare, 2015). Both TB and HIV have profound effects on the immune system, as they are capable of disarming the host’s immune responses. HIV co-infection is the most powerful known risk factor for progression of M. tuberculosis infection to activate the disease, increasing the risk of latent TB reactivation 20-fold. Likewise, TB Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 117 © Adama Science & Technology University https://ejssd.astu.edu.et has been reported to exacerbate HIV infection (Pawlowski et al., 2012). Most of the (79 %) TB/HIV co-infected patients had followed ART. The ART level shows variation in the country that 76.3 % was reported in Northern Amhara (Daniel et al., 2015), 79.2 % in southwestern Ethiopia (EPHI, 2015), 54.6 % in Addis Ababa (Mesfin, 2011), and 89.8 % in Oromia (Oromia Region Health Bureau, 2015). In its National TB/HIV Sentinel Surveillance, the Ethiopian Public Health Institute (EPHI) (2015) reported that at national level 70 % of TB/HIV co- infected patients have started or continued previously initiated ART during the course of their TB treatment. According to the recent report ART improves treatment outcome of TB/HIV co-infected individuals reduce early mortality from HIV/TB co-infection, and reduce TB transmission when ART is initiated earlier in all individuals with TB and improved management of TB. Hence programs need to provide due attention to the quality of TB/HIV care and put all TB/HIV co- infected patients on ART treatment as part of the TB/HIV co-management and as per the 100 % recommendation in the national guideline (EPHI, 2015). About 65 % of the TB patients completed treatment, 13 % cured and 4.5 % (n = 46) of the total patients died. Treatment success defined as ‘treatment completed and cured’ after completion of dose regimen was 80 % and it is lower than the target set in Ethiopia to achieve overall treatment success rate of 89 % (EFMoH, 2013). The treatment success recorded in the current study shows variation from other similar studies conducted in different hospitals in the country. For instance, Tigist and Mulugeta Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 118 © Adama Science & Technology University https://ejssd.astu.edu.et (2015) recorded 86 % treatment success at Jimma University Specialized Hospital and Omonada training health center, 87 % at Debretabor Hospital (Adisu et al., 2016), 64 % at Adama Hospital, 29 % (Fiseha et al., 2015), and 63.4 % at Gambella Regional hospital (Getahun et al., 2015). This study revealed a constant trend in the percentage of TB/HIV co-infection from 2012 to 2014 but an increased trend from 2014 to 2016. Earlier there was an increased awareness creation about HIV through health education and mass media on prevention and its control. However, currently less attention is given to the disease and thus it has been reviving. The present study found that treatment success (defined as treatment completed and cured) after completion of dose regimen was 80 % and it less than the target set in Ethiopia to achieve overall treatment success rate of 89 % (EFMoH, 2013). Tigist and Mulugeta (2015) reported 86 % treatment success at Jimma University Specialized Hospital and Omonada training health center, while Adisu et al. (2016) reported 87.1 % at Debretabor Hospital. At Adama Hospital (64 %) (Lenjisa et al., 2015) and Mizan Aman General Hospital (29 %) (Fiseha et al., 2015) reported lower rate of treatment success. 6. Cnclusion The prevalence of TB/HIV co-infection in this study was high (21 %) and the percentage of co- infection is higher in females than males, single than married individuals, unemployed than employed and active working force than other age groups. The ART coverage of the TB/HIV co- infected patients was 78 % which was lower than WHO target of 100 Bizuayehu M. & Daniel G. Ethiop. J. Sci. Sustain. Dev., 5 (1), 2018 119 © Adama Science & Technology University https://ejssd.astu.edu.et %. The present study showed that there was an increase TB/HIV co- infection trend from 2014 to 2016. Economic empowerment of females, awareness creation about prevention of TB and HIV/AIDS and job creation for jobless citizens, especially for those in the active working age can be used as intervention mechanisms of the diseases. Acknowledgements The authors wish to thank the management and staff of HIV care units of Metehara Sugar Factory Hospital for providing necessary facilities used in carrying out this study. Special thanks also go to Oromia Education Bureau and Adama Science and Technology University for funding the study. References Abera Bekele, Kate Flaming, Zelalem Habtamu and Andrew Fogarty (2009). The association of TB with HIV infection in Oromia Regional National State, Ethiopia. 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