Prevalence and associated factors of tuberculosis/HIV coinfection among people living with HIV in Almaty, Kazakhstan: a cross-sectional study
Tuberculosis (TB) is the leading cause of death among people living with HIV (PLHIV). Kazakhstan faces a growing number of new HIV diagnoses alongside a high incidence of multidrug-resistant TB. This study aimed to determine the prevalence and risk factors for TB among PLHIV in Almaty, Kazakhstan. We conducted a cross-sectional study of adult PLHIV receiving care at the Almaty AIDS City Center by 2022. Participants were randomly selected from the HIV registry. TB/HIV coinfection was defined as a documented TB diagnosis following HIV diagnosis in the registry. Bivariable and multivariable Poisson regression with robust standard errors was used to estimate unadjusted and adjusted prevalence ratios (PR and aPR) and 95% confidence intervals (CI) for factors associated with TB/HIV coinfection. Of 194 PLHIV randomly selected, 188 participated, of whom 32 (17%) had TB/HIV coinfection. In bivariable analysis, coinfection was more common among those with lower educational attainment (24% vs. 6%), a history of incarceration (43% vs. 11%), ever smoking (32% vs. 4%), known TB contact (28% vs. 5%), detectable viral load (>50 copies/mL; 42% vs. 3% among those with undetectable viral load ≤50 copies/mL), ART duration less than three years (13% vs. 1%), and ART interruptions (16% vs. 3%). Coinfection prevalence was also higher among those with a CD4 cell count <200 cells/mm 3 (44% vs. 12%), and those with no or unknown TPT receipt had a higher prevalence of coinfection compared to those who had received TPT (25% vs. 10%; PR = 2.5; 95% CI: 1.2–5.5). In multivariable analysis, coinfection was independently associated with younger age (18–39 vs. ≥40 years; aPR = 2.0; 95% CI: 1.2–3.4), ever smoking (aPR = 3.6; 95% CI: 1.3–10.0), known TB contact (aPR = 2.4; 95% CI: 1.0–5.7), incarceration history (aPR = 1.8; 95% CI: 1.1–3.2), and detectable viral load (aPR = 6.9; 95% CI: 2.5–19.5). We found a high prevalence of TB/HIV coinfection and suboptimal TPT coverage among PLHIV in Almaty. Expanding TPT access, ensuring routine TB screening, and prioritizing early and sustained ART, particularly among individuals with detectable viral loads or low CD4 counts, may help reduce TB among PLHIV in similar settings.