Abstract
(1) Background: In resource-limited countries, patients with tuberculosis (TB)/HIV coinfection commonly face economic, sociocultural, and behavioral barriers to effective treatment. These barriers manifest from low treatment literacy, poverty, gender inequality, malnutrition, societal stigmas regarding HIV, and an absence of available care. It is critical for intervention programs to understand and assist in overcoming these barriers and any additional risks encountered by patients with TB/HIV coinfection. This study analyzes variation in TB/HIV coinfection and risks of negative outcomes among patients with TB/HIV coinfection compared to those without coinfection. (2) Methods: This quantitative study used data from 49,460 patients receiving ART from 241 HIV/AIDS clinics in Haut-Katanga and Kinshasa, two provinces in the Democratic Republic of Congo. Chi-square and logistic regression analysis were performed. (3) Results: Significantly higher proportions of patients with TB/HIV coinfection were men (4.5%; women, 3.3%), were new patients (3.7%; transferred-in, 1.6%), resided in the Kinshasa province (4.0%; Haut-Katanga, 2.7%), and were in an urban health zone (3.9%) or semi-rural health zone (3.1%; rural, 1.2%). Logistic regression analysis showed that after controlling for demographic and clinical variables, TB/HIV coinfection increased the risk of death (adjusted odds ratio (AOR), 2.26 (95% confidence interval (CI): 1.94–2.64)) and LTFU (AOR, 2.06 (95% CI: 1.82–2.34)). TB/HIV coinfection decreased the odds of viral load suppression (AOR, 0.58 (95% CI: 0.46–0.74)). (4) Conclusions: TB/HIV coinfection raises the risk of negative outcomes such as death, LTFU, and lack of viral load suppression. Our findings can help HIV clinics in Democratic Republic of Congo and other African countries to customize their interventions to improve HIV care and reduce care disparities among patients.
Highlights
According to the World Health Organization (WHO), Africa Region has the highest proportion of TB/HIV coinfection and of the 251,000 deaths from HIV-associated TB in 2019, approximately 84% were in sub-Saharan Africa [3]
The health zones send data to the province, which in turn shared those data to the national level repository, using the electronic system. This dataset with a limited number of demographic and clinical variables was obtained from the National HIV/AIDS Program (PNLS) national electronic patient management system, which manages the HIV clinics owned by the Democratic Republic of Congo (DRC) government supported by Centers for Disease Control and Prevention (CDC) implementing partners (ICAP and EGPAF) via the President’s Emergency Plan for AIDS Relief (PEPFAR)
We found that TB/HIV coinfection increases the risk of negative outcomes for people living with HIV/AIDS (PLWH), including death, loss to follow-up (LTFU), and lack of viral load suppression
Summary
In sub-Saharan Africa, tuberculosis (TB) and HIV coinfection has been associated with high morbidity and mortality rates among people living with HIV/AIDS [1,2]. According to the World Health Organization (WHO), Africa Region has the highest proportion of TB/HIV coinfection and of the 251,000 deaths from HIV-associated TB in 2019, approximately 84% were in sub-Saharan Africa [3]. The estimated epidemiological burden in Central and Western Africa finds six of these countries on the list of the 30 highest TB burdened countries; for 2019, TB/HIV co-infection cases in these six countries range from.
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