Background: The introduction of antiretroviral therapy (ART) significantly decreases the incidence of tuberculosis (TB) in Human Immunodeficiency Virus ( HIV) positive individuals during their follow-up. However, a considerable proportion is still co-infected with TB after ART initiation. Thus, this study aimed to assess the determinants of TB incidence among HIV-positive individuals during their ART follow-up in Addis Ababa, Ethiopia. Methods: A nested case-control study was conducted among HIV-positive individuals who were enrolled in ART clinics in Addis Ababa, Ethiopia from 2013 up to 2018. Cases were tuberculosis co-infected HIV positive individuals who were taking antiretroviral treatment, while controls were TB free HIV positive individuals who were taking antiretroviral treatment. The cases and controls are matched exactly in age and sex. Data were entered in EpiInfo version 7.1 and analyzed using SPSS version 20. Bivariable and multivariable conditional logistic regression were employed along with 95% CI. A P-value <0.05 in the multivariable analysis was considered statistically significant. Results: Fifty-seven cases were compared with 114 controls pair-matched exactly in age and sex. Accordingly, previous TB history (X 2; 13.790 , P<0.001), baseline functional status (X 2; 9.120 , P=0.010), baseline WHO clinical stage (X 2; 10.083 , P=0.001), baseline hemoglobin value (X 2; 6.985 , P=0.008), baseline body mass index (X 2; 3.873 , P=0.049), isoniazid preventive treatment intake status (X 2; 8.047 , P=0.005), baseline CD4 value (X 2; 12.741 , P<0.001) and length of stay on ART (X 2; 53.359 , P<0.001) were associated with TB infection. Length of stay on ART was found to be the statistically significant determinant of TB infection after ART initiation (aOR=5.925, 95%CI=2.649-13.250). Conclusion: Advanced clinical stages at the baseline, previous TB history, and not taking IPT were associated with TB infection. The long term ART exposure significantly decreases tuberculosis incidence in HIV patients. Screening HIV-positive patients for tuberculosis throughout their ART follow-up would be important early detection and treatment of tuberculosis.

The emergence of drug-resistant tuberculosis (DR-TB) is becoming a challenge to the national TB control programs including Ethiopia. Different risk factors are associated with the emergence of DR-TB. Identifying these risk factors in a local setting is important to strengthen the effort to prevent and control DR-TB. Thus, this study aimed to assess the risk factors associated with drug-resistant TB in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist was followed to conduct this study. We systematically searched the articles from electronic databases and gray literature sources. We used the Joanna Briggs Institute Critical Appraisal tools to assess the quality of studies. Data were analyzed using STATA version 15. We estimated the pooled OR along with 95%CI for each risk factor. The heterogeneity of the studies was assessed using the forest plot and I 2 heterogeneity test. Besides, we explored the presence of publication bias through visual inspection of the funnel plot and Egger’s regression test. After intense searching, we found 2238 articles, and 27 eligible studies were included in the final analysis. Based on the pooled analysis of the odds ratio, unemployment (OR; 2.71, 95% CI; 1.64, 3.78), having a history of the previous TB (OR; 4.83, 95% CI; 3.02, 6.64), having contact with a known TB patient (OR; 1.72, 95% CI; 1.05, 2.40), having contact with a known MDR-TB patient (OR; 2.54, 95% CI; 1.46, 3.63), and having pulmonary TB (OR; 1.80, 95% CI; 1.14, 2.45) were found to be the risk factors of drug-resistant TB. While older age TB patients (OR; 0.77, 95% CI; 0.60, 0.95) including age above 45 years OR; (0.76, 95% CI; 0.55, 0.97), and males (OR; 0.86, 95% CI; 0.76, 0.97) were found to had lower risk of DR-TB compared to their counterparts. A previous history of TB treatment is a major risk factor for acquiring DR-TB in Ethiopia that might be due to poor adherence during the first-line anti TB treatment. Besides, having contact with a known TB patient, having contact with a known MDR-TB patient, having pulmonary TB, and being unemployed were the risk factors of DR-TB in Ethiopia. Thus, active screening of TB contacts for DR-TB might help to detect DR-TB cases as early as possible and could help to mitigate its further transmission across the community.