Epidemiological risk factors for HIV/TB co-infection among patients receiving antiretroviral therapy in selected hospitals in Ibadan, Nigeria: a case-control study

Epidemiological risk factors for HIV/TB co-infection among patients receiving antiretroviral therapy in selected hospitals in Ibadan, Nigeria: a case-control study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Epidemiological risk factors for HIV/TB co-infection among patients receiving antiretroviral therapy in selected hospitals in Ibadan, Nigeria: a case-control study Adesewa Idowu Ajibade, Nnodimele Atulomah, Luke Oche Peter This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9497252/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: Despite the scale-up of antiretroviral therapy (ART), active tuberculosis (TB) remains a major complication among people living with HIV (PLHIV). This study identified epidemiological risk factors for active TB among PLHIV receiving ART in Ibadan, Nigeria. Methods: A case–control study was conducted among 346 consenting PLHIV on ART (173 cases with active TB and 173 controls without TB) across selected hospitals in Ibadan, Nigeria. Data were collected using an interviewer-administered validated questionnaire and clinical records. Variables included socio-demographic, clinical, behavioral, psychosocial, and environmental factors. Data were analyzed using SPSS v.21 with level of significance at p ≤ 0.05. Results: Cases had significantly poorer clinical profiles than controls, with higher prevalence of unsuppressed viral load (69.4% vs. 32.4%, p<0.001) and CD4 count <200 cells/µL (89.6% vs. 75.7%, p=0.001). Mean ART adherence was lower among cases (11.76 ± 2.40) compared with controls (12.73 ± 1.86, p<0.001). Similarly, cases demonstrated less favorable attitudinal dispositions toward ART and TB treatment adherence than controls (17.02 ± 4.97 vs. 18.84 ± 3.66, p<0.001). In multivariate analysis, unsuppressed viral load (AOR=4.70; 95% CI: 2.80–7.87; p<0.05), CD4 count <200 cells/µL (AOR=2.60; 95% CI: 1.30–5.23; p<0.05), lower ART adherence (AOR=0.82; 95% CI: 0.71–0.94; p<0.05), and less favorable attitudinal dispositions toward treatment (AOR=0.87; 95% CI: 0.80–0.94;p<0.05) were independent predictors of HIV/TB co-infection with unsuppressed viral load being the most significant predictor (AOR=4.70; 95% CI: 2.80–7.87; p<0.05). Conclusion: Viral load, CD4 count, ART adherence, and attitudinal dispositions are significant predictors of HIV/TB co-infection, however, viral load appears to represent an important epidemiological goal of note in treatment outcomes. There is a need to strengthen integrated HIV/TB services with a focus on improving ART adherence and addressing attitudinal dispositions of the patients along with perceptions of expected outcomes and consequences through targeted counseling and support interventions. Clinical trial number: Not applicable HIV/TB co-infection tuberculosis antiretroviral therapy viral load CD4 count ART adherence people living with HIV epidemiological risk factors Full Text Additional Declarations No competing interests reported. Supplementary Files HIVTBDataset.xls Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 24 Apr, 2026 Editor assigned by journal 23 Apr, 2026 Submission checks completed at journal 23 Apr, 2026 First submitted to journal 22 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9497252","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":628008279,"identity":"299233df-6e56-4ba2-9064-a21fd294d051","order_by":0,"name":"Adesewa Idowu Ajibade","email":"data:image/png;base64,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","orcid":"","institution":"Babcock University","correspondingAuthor":true,"prefix":"","firstName":"Adesewa","middleName":"Idowu","lastName":"Ajibade","suffix":""},{"id":628008281,"identity":"b92b5bbf-e0cd-46f0-b5ae-987e7bd00da2","order_by":1,"name":"Nnodimele Atulomah","email":"","orcid":"","institution":"Babcock University","correspondingAuthor":false,"prefix":"","firstName":"Nnodimele","middleName":"","lastName":"Atulomah","suffix":""},{"id":628008285,"identity":"c1a1d4ed-6bec-4e16-803d-4b02a62bf204","order_by":2,"name":"Luke Oche Peter","email":"","orcid":"","institution":"University of Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Luke","middleName":"Oche","lastName":"Peter","suffix":""}],"badges":[],"createdAt":"2026-04-22 13:53:47","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9497252/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9497252/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107706130,"identity":"aec0fe72-3aa1-41e8-af64-18666b61f067","added_by":"auto","created_at":"2026-04-24 09:17:28","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":401920,"visible":true,"origin":"","legend":"","description":"","filename":"HIVTBBMCPHmanuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9497252/v1_covered_65b847e6-37d3-4c01-bcc7-3db9d7d6adde.pdf"},{"id":107609362,"identity":"404d9761-2d9c-4ef9-b2f4-ffc0f48ebb2b","added_by":"auto","created_at":"2026-04-23 08:14:29","extension":"xls","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":411683,"visible":true,"origin":"","legend":"","description":"","filename":"HIVTBDataset.xls","url":"https://assets-eu.researchsquare.com/files/rs-9497252/v1/156bf6d926b33af0ea4d7390.xls"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemiological risk factors for HIV/TB co-infection among patients receiving antiretroviral therapy in selected hospitals in Ibadan, Nigeria: a case-control study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HIV/TB co-infection, tuberculosis, antiretroviral therapy, viral load, CD4 count, ART adherence, people living with HIV, epidemiological risk factors","lastPublishedDoi":"10.21203/rs.3.rs-9497252/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9497252/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Despite the scale-up of antiretroviral therapy (ART), active tuberculosis (TB) remains a major complication among people living with HIV (PLHIV). This study identified epidemiological risk factors for active TB among PLHIV receiving ART in Ibadan, Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A case–control study was conducted among 346 consenting PLHIV on ART (173 cases with active TB and 173 controls without TB) across selected hospitals in Ibadan, Nigeria. Data were collected using an interviewer-administered validated questionnaire and clinical records. Variables included socio-demographic, clinical, behavioral, psychosocial, and environmental factors. Data were analyzed using SPSS v.21 with level of significance at p ≤ 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Cases had significantly poorer clinical profiles than controls, with higher prevalence of unsuppressed viral load (69.4% vs. 32.4%, p\u0026lt;0.001) and CD4 count \u0026lt;200 cells/µL (89.6% vs. 75.7%, p=0.001). Mean ART adherence was lower among cases (11.76 ± 2.40) compared with controls (12.73 ± 1.86, p\u0026lt;0.001). Similarly, cases demonstrated less favorable attitudinal dispositions toward ART and TB treatment adherence than controls (17.02 ± 4.97 vs. 18.84 ± 3.66, p\u0026lt;0.001). In multivariate analysis, unsuppressed viral load (AOR=4.70; 95% CI: 2.80–7.87; p\u0026lt;0.05), CD4 count \u0026lt;200 cells/µL (AOR=2.60; 95% CI: 1.30–5.23; p\u0026lt;0.05), lower ART adherence (AOR=0.82; 95% CI: 0.71–0.94; p\u0026lt;0.05), and less favorable attitudinal dispositions toward treatment (AOR=0.87; 95% CI: 0.80–0.94;p\u0026lt;0.05) were independent predictors of HIV/TB co-infection with unsuppressed viral load being the most significant predictor (AOR=4.70; 95% CI: 2.80–7.87; p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Viral load, CD4 count, ART adherence, and attitudinal dispositions are significant predictors of HIV/TB co-infection, however, viral load appears to represent an important epidemiological goal of note in treatment outcomes. There is a need to strengthen integrated HIV/TB services with a focus on improving ART adherence and addressing attitudinal dispositions of the patients along with perceptions of expected outcomes and consequences through targeted counseling and support interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number: \u003c/strong\u003eNot applicable\u003c/p\u003e","manuscriptTitle":"Epidemiological risk factors for HIV/TB co-infection among patients receiving antiretroviral therapy in selected hospitals in Ibadan, Nigeria: a case-control study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-23 08:14:25","doi":"10.21203/rs.3.rs-9497252/v1","editorialEvents":[{"type":"communityComments","content":3},{"type":"decision","content":"Revision requested","date":"2026-04-24T08:33:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-23T04:20:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-23T04:19:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-04-22T13:49:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bb1f1cd4-5037-4438-9f79-bca36de1297f","owner":[],"postedDate":"April 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T11:08:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-23 08:14:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9497252","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9497252","identity":"rs-9497252","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}