Mixed results in TB care for people with HIV in Nasarawa State

Ending the global tuberculosis (TB) epidemic by 2030 is one of the United Nations Sustainable Development Goals, and Nigeria must strengthen collaborative TB/HIV care at all levels to reach that aim. In Nasarawa State, researchers led by Benjamin Mari Aya set out to compare how people living with HIV (PLWH) fare when treated for TB at different types of health facilities. The team carried out a facility-based retrospective survey, looking back through medical records from two tertiary healthcare facilities and one primary healthcare centre (PHC) in the state. They focused on patients living with HIV who completed TB treatment between January 2016 and December 2019. Using a standard data pro forma, the researchers recorded each patient’s treatment outcome and then grouped outcomes as either successful or unsuccessful. The study was designed to shine a light on whether treatment success differs by level of care and to inform efforts to strengthen collaborative TB/HIV services across facilities in Nasarawa State and beyond.

The study reviewed records for 959 people living with HIV who were treated for TB. The average age was 33 years (±14), 847 were adults (88.3%), and 499 (52%) were female. Researchers used descriptive and inferential analysis and ran multivariate logistic regression to identify predictors of success. Overall, 26% of patients completed TB treatment and 20.5% were recorded as cured, giving a treatment success rate (TSR) of 46.5%. The mortality rate among the group was 9.2%. The TSR declined over time, from 68.8% in 2016 to 57.6% in 2019. Tertiary healthcare facilities showed the highest rates of unsuccessful treatment compared with the PHC, and within tertiary facilities treatment failure, death, and loss to follow-up were highest. Paradoxically, being treated at a tertiary healthcare facility was also associated with higher odds of a successful treatment outcome (adjusted odds ratio = 3.6, confidence interval 2.0–6.6).

The study’s findings point to a worrying picture: overall treatment success for TB among people living with HIV in these facilities was under 50% and declined across the four-year period examined. While the proportion of patients who completed treatment (26%) and those documented as cured (20.5%) represent the study’s measured successes, they still amount to a low TSR and leave many with unfavourable outcomes. The contrast between higher unsuccessful rates at tertiary centres and the statistical finding that care at tertiary facilities predicted success suggests complexity in how care is delivered, documented, or which patients attend which facility. These mixed results underline the need for strengthened collaborative TB/HIV care at all levels of the health system, better follow-up to prevent loss to follow-up, and more investigation into why outcomes differ between primary and tertiary facilities so resources and support can be targeted where they are most needed.