Low TB/HIV treatment success in Port Harcourt despite high ART and CPT use

Tuberculosis (TB) remains a leading health challenge for people living with HIV, and careful monitoring of treatment is essential to keep patients on track. In a study led by Prince Chinonso Nnadozie, researchers reviewed the records of people treated for both TB and HIV to measure how well care systems were working. The team focused on patients enrolled in the Directly Observed Treatment Short course (DOTS) program at a tertiary-care hospital in Port Harcourt, Nigeria. They conducted a retrospective review of six years of records, from January 1, 2014 to December 31, 2019, to see who completed treatment, who was cured, and who experienced poor outcomes like death, treatment failure, or being lost to follow-up. By examining routine program records, the study aimed to highlight practical gaps in everyday clinical practice and to show where improvements could make the biggest difference for people living with TB/HIV co-infection in this setting.

The researchers extracted data from the National TB program register and analyzed it using IBM SPSS version30.0. They included 305 TB/HIV co-infected patients in the analysis. The group had a mean age of 29.2 years, with 29.8% aged 0–14 years; 89.5% were new TB cases and 89.2% had pulmonary TB (PTB). Males made up 50.2% and females 49.8%. Uptake of Antiretroviral therapy (ART) was 95.1% and cotrimoxazole preventive therapy (CPT) was 93.4%. Treatment outcomes were detailed: 19.0% cured, 23.3% completed treatment, 0.3% failed treatment, 23.6% died, 14.8% were lost to follow-up, 10.8% transferred out, and 8.2% were not evaluated. Overall treatment success (cured plus completed) was 52.2%. Bivariate and multivariate logistic regressions at 95% confidence intervals identified age groups (15–24 years: AOR=6.35, 95%CI:1.56–25.86; 25–34 years: AOR=3.97, 95%CI:1.37–11.45; 45–54 years: AOR=6.40, 95%CI:2.27–18.06) and use of an alternative diagnostic method (AOR=0.32, 95%CI:0.12–0.76) as significantly associated with unsuccessful treatment outcomes.

The findings point to a clear problem: despite very high uptake of ART and CPT among people with TB/HIV co-infection, the overall treatment success rate was only 52.2%, a level the authors say falls below the WHO target. High death and loss-to-follow-up rates contributed to this low success rate, and certain age groups faced substantially higher odds of an unsuccessful outcome. The statistical link with alternative diagnostic methods suggests diagnostic practice and the tools used may influence outcomes, and that strengthening or standardizing diagnostic approaches could be part of the solution. The study underscores the need to combine medical treatment with program-level changes — for example, targeted interventions for vulnerable age groups, improved follow-up to prevent loss to care, and attention to which diagnostic methods are used in practice. Translating these findings into policy and clinical practice could help improve the chances of cure and completion for people living with both TB and HIV in similar settings.