Association between HIV Co-infection and Tuberculosis Treatment Outcomes in Rural Primary Health Care Settings in Rivers State, Nigeria: A Retrospective Cohort Study

Abstract

Background: Tuberculosis and HIV co-infection remain important public health challenges in sub-Saharan Africa, particularly in rural settings where access to integrated care may be limited. This study assessed the association between HIV co-infection and tuberculosis treatment outcomes among patients receiving care in rural primary health care facilities in Rivers State, Nigeria. Methods: A retrospective analytical cohort study was conducted using routine tuberculosis treatment records from six primary health care facilities in three rural local government areas of Rivers State. Records of patients treated between June 2020 and May 2025 were reviewed. A total of 214 tuberculosis patients with documented HIV status and treatment outcomes were included, comprising 107 HIV-positive and 107 HIV-negative patients. The primary outcome was tuberculosis treatment outcome, classified as successful or unsuccessful. Descriptive statistics were used to summarise patient characteristics, while multivariate logistic regression was performed to identify predictors of unsuccessful treatment outcomes. Adjusted odds ratios with 95% confidence intervals were reported. Results: The mean age of participants was 38.6 ± 14.2 years, and 52.3% were male. Overall, 178 patients (83.2%) had successful treatment outcomes, while 36 (16.8%) had unsuccessful outcomes. Unsuccessful treatment was more frequent among HIV-positive patients than among HIV-negative patients (25.2% versus 8.4%). After adjustment, HIV co-infection was significantly associated with unsuccessful tuberculosis treatment outcomes (AOR = 3.68; 95% CI: 1.57–8.63; p = 0.003). Other independent predictors were age ≥45 years, retreatment status, and poor adherence. Conclusion: HIV co-infection was independently associated with poorer tuberculosis treatment outcomes in rural primary health care settings in Rivers State. Strengthening integrated TB/HIV services and adherence support may improve treatment outcomes in similar resource-limited settings.