Incidence and Predictors of Tuberculosis Among Adults Living With HIV/AIDS on Antiretroviral Therapy in Central Gondar Zone, Northwest Ethiopia: A Multicenter Retrospective Follow-Up Study
Jan 2026· Journal of the International Association of Providers of AIDS Care· Vol 25· 0 citations· 35 references
Medicine
TL;DR
Tuberculosis incidence was relatively low, while isoniazid use was protective, and poor adherence, opportunistic infections, and large family size increased risk, while isoniazid use was protective.
Abstract
Background Tuberculosis is a major communicable disease and the leading cause of death among people living with HIV/AIDS, accounting for nearly 40% of AIDS-related deaths. This study assessed the incidence and predictors of tuberculosis among adults receiving antiretroviral therapy in Central Gondar Zone, Northwest Ethiopia, from December 2016 to January 2022. Methods A multicenter retrospective follow-up study was conducted among 488 adult HIV-positive individuals on antiretroviral therapy. Data were collected using an Android-based mobile application and analyzed using a Cox proportional hazards model. Variables with p < 0.05 were considered significant predictors. Results The tuberculosis incidence rate was 2.87 per 100 person-years (95% CI: 2.22–3.70). Increased risk was associated with opportunistic infections (Adjusted Hazard Ratio (AHR)=3.16), poor antiretroviral therapy (ART) adherence (Adjusted Hazard Ratio (AHR)=3.53), and family size ≥5 (AHR=2.36). Isoniazid preventive therapy (IPT) reduced tuberculosis risk (AHR≈0.26–0.29). Conclusion Tuberculosis incidence was relatively low. Poor adherence, opportunistic infections, and large family size increased risk, while isoniazid use was protective.
The incidence of LTFU among adults on ART in Guji zone was high, particularly during the first year of treatment, and targeted interventions including enhanced counseling for high-risk groups, community-based ART refill models, and active phone-based tracking systems should be implemented to improve retention.
Human immunodeficiency virus (HIV) remains a major public health challenge, with clinical manifestations and risk-related behaviors influencing disease progression and transmission. A retrospective cross-sectional hospital-based study of the socio-demographic characteristics, clinical profiles, treatment patterns, and behavioral risk factors among 196 people living with HIV/AIDS (PLWHA) in El-Obeid city, with a complete response rate of 100% (total coverage). Data were analyzed and processed using the Statistical Package for Social Sciences (SPSS), version 23.0, and Microsoft Excel 2010, and results were presented using tables and figures. The majority of participants were aged between 26 and 45 years. Male participants constituted 56.1% of the study population. Almost all participants-initiated ART immediately after diagnosis. Nearly half of the participants reported suffering from chronic diseases. TB was the most prevalent comorbidity, affecting 50% of those with chronic conditions. Sexual transmission was identified as the primary risk factor, accounting for nearly 60% of infections. Approximately 15% of respondents reported having more than three sexual partners. HIV/AIDS among PLWHA is associated with low condom utilization the first time they had sex, multiple sexual partners, alcohol consumption, early sexual debut, substance abuse, and socio-economic vulnerability.
Radi Mahmoud Hassan Hammad, Mohammed Salaman Gumaa Fadalla, M. Mohammed· Center of Medicine· 0 citations
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.
Alfiya Y. Denebayeva, Elizabeth J. King, Zhamilya Nugmanova et al.· Frontiers in Public Health· 0 citations
BACKGROUND
Tuberculosis (TB) is a significant cause of mortality among people living with HIV (PLWH), in Nepal. HIV increases the risk of progression from latent to active TB, increasing mortality. Despite established TB control programs, there is a significant lack of recent data measuring the tuberculosis burden among PLWH specially within the Western region of Nepal. This study was conducted to assess the prevalence of pulmonary tuberculosis among HIV-positive patients attending a tertiary care centre in Gandaki Province, Nepal.
METHODS
A hospital-based cross-sectional study was conducted at Western Regional Hospital, Pokhara Academy of Health Sciences, from August 2025 to January 2026. First, HIV-positive patients attending the ART clinic were screened, and those aged ?18 years without prior tuberculosis were included. Next, participants were recruited using convenience sampling. After obtaining informed consent, sociodemographic and clinical data were collected through a structured questionnaire and medical record review. Subsequently, CD4 counts were measured using the PIMA CD4 analyser, and sputum samples were examined using Ziehl-Neelsen staining for acid-fast bacilli. Finally, data were analysed using SPSS version 22, with p < 0.05 considered statistically significant.
RESULTS
Prevalence of pulmonary TB was found to be 5.1% among 137 participants. TB co-infection was found to be higher among males and in the 20-29 years and >70 years age groups. TB was more common among those with CD4 counts <200 cells/µL, but was not statistically significant.
CONCLUSIONS
The study found a 5.1% prevalence of pulmonary TB among PLWH in western Nepal and highlights the need for regular TB screening.
Shisir Pokhrel, S. Regmi, Kripa Ghimire et al.· Journal of Nepal Health Rese...· 0 citations
Objective This study aimed to identify determinants of late ART initiation among adults living with HIV in public health facilities of West Guji Zone, Oromia, Ethiopia. Methods Unmatched case–control study was conducted among 226 adults living with HIV (113 cases and 113 controls) selected by simple random sampling. Data was collected using an interviewer-administered questionnaire and analyzed using SPSS version 25. Multivariable logistic binary regression was used to identify determinants of late ART initiation. Results Late ART initiation was associated with inability to read and write (AOR = 6.21, 95% CI: 2.32–7.98), rural residence (AOR = 4.26, 95% CI: 1.23–14.74), fear of job loss (AOR = 8.43, 95% CI: 6.72–20.05), lack of family support (AOR = 7.28, 95% CI: 1.90–12.19), absence of intention to protect family members (AOR = 6.16, 95% CI: 4.15–12.97), visiting traditional healers (AOR = 5.24, 95% CI: 1.51–13.40), and contact with commercial sex workers (AOR =5.59, 95% CI: 4.07–13.80). Conclusions Delayed ART initiation was driven by interacting sociodemographic, psychosocial, and behavioral factors. Addressing social disadvantages, fear-related concerns, weak family support, and reliance on non-formal care pathways is essential to promote timely initiation of ART.
Atsedemariam Mamo, Melese Tikusie Tewoldie, Z. B. Mamo· Journal of the International...· 0 citations
Background Community-based ART service delivery brings HIV care closer to clinically stable clients and may improve outcomes while reducing burdens on patients and health facilities. However, evidence from low income setting remains limited. Methods Institution based retrospective follow-up study was conducted from 422 adult ART users selected by simple random sampling. Data were analyzed using STATA 15. Multivariable Cox proportional hazards regression identified predictors of treatment outcomes. Results The cumulative incidence of good ART treatment outcome was 81.99% (95% CI: 77.98–85.54%). Median survival time was 11 months (IQR: 5–12). Missing ART doses reduced survival by 54% (AHR=0.46; 95% CI: 0.22–0.95). Good retention in care (AHR=1.58), tuberculosis prophylaxis (AHR=1.38), and adequate drug supply (AHR=1.39) significantly improved survival. Conclusion Treatment outcomes were suboptimal. Strengthening retention, tuberculosis prophylaxis, drug supply, and adherence support could improve survival.
Tadewos Kassaw Tarekegn, Hailemarriam Mekonnen, Birhanu Melaku et al.· Journal of the International...· 0 citations
