BMJ public health · 2025
Understanding the epidemiology of TB-HIV co-infection in Indonesia: evidence from the 2023 national TB registry.
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Machrumnizar Machrumnizar, Eryando Tris, Bachtiar Adang, Kusumaratna Rina Kurniasri, Meiyanti Meiyanti, Djuana Endang, Hidayah Nikmatul, Alfiyyah Arifah
Аннотация
INTRODUCTION: Tuberculosis (TB) and HIV co-infection remain a significant public health challenge in Indonesia. Therefore, this study aims to identify the determinants and epidemiological characteristics of TB-HIV co-infection using data from the 2023 national TB registry.
METHODS: The study procedures were carried out using a cross-sectional design, analysing univariate, bivariate and multivariate associations between TB-HIV coinfection status and demographic, clinical and health service factors among patients with TB.
RESULTS: Among 22 698 patients with TB, 94.8% were HIV negative, with a predominance of males (58.8%) and adults aged 30-59 years (49.8%). The majority of the patients were treated in healthcare facilities located in Western Indonesia, had pulmonary TB (93.8%), bacteriological diagnosis (55.5%) and achieved a cure (85.9%), while the remaining 14.1% included patients who died, were lost to follow-up, or had incomplete treatment outcomes. The most common nutritional status among patients was normal nutritional status (44.4%). In the multivariate analysis, clinical diagnosis remained the strongest predictor of TB-HIV co-infection (OR 2.446; 95% CI 2.154 to 2.778; p<0.001). Other significant predictors included male sex (OR 2.096; 95% CI 1.835 to 2.395), extrapulmonary TB (OR 1.337; 95% CI 1.075 to 1.662) and undernourished status, which showed lower odds of TB-HIV co-infection compared with overweight or obese patients (OR 0.809; 95% CI 0.676 to 0.967).
CONCLUSIONS: This study highlights TB-HIV co-infection as the primary outcome, emphasising the role of demographic, clinical, nutritional and regional disparities in influencing co-infection risks. The findings underscore the need for integrated TB-HIV diagnostic and management strategies, including nutritional support and targeted interventions focusing on high-risk populations and health service accessibility to strengthen early detection and treatment outcomes.
METHODS: The study procedures were carried out using a cross-sectional design, analysing univariate, bivariate and multivariate associations between TB-HIV coinfection status and demographic, clinical and health service factors among patients with TB.
RESULTS: Among 22 698 patients with TB, 94.8% were HIV negative, with a predominance of males (58.8%) and adults aged 30-59 years (49.8%). The majority of the patients were treated in healthcare facilities located in Western Indonesia, had pulmonary TB (93.8%), bacteriological diagnosis (55.5%) and achieved a cure (85.9%), while the remaining 14.1% included patients who died, were lost to follow-up, or had incomplete treatment outcomes. The most common nutritional status among patients was normal nutritional status (44.4%). In the multivariate analysis, clinical diagnosis remained the strongest predictor of TB-HIV co-infection (OR 2.446; 95% CI 2.154 to 2.778; p<0.001). Other significant predictors included male sex (OR 2.096; 95% CI 1.835 to 2.395), extrapulmonary TB (OR 1.337; 95% CI 1.075 to 1.662) and undernourished status, which showed lower odds of TB-HIV co-infection compared with overweight or obese patients (OR 0.809; 95% CI 0.676 to 0.967).
CONCLUSIONS: This study highlights TB-HIV co-infection as the primary outcome, emphasising the role of demographic, clinical, nutritional and regional disparities in influencing co-infection risks. The findings underscore the need for integrated TB-HIV diagnostic and management strategies, including nutritional support and targeted interventions focusing on high-risk populations and health service accessibility to strengthen early detection and treatment outcomes.