Prevalence and predictors of HIV/TB co-infection in Sub-Saharan Africa

Background In Sub-Saharan Africa (SSA), tuberculosis is a leading cause of morbidity and mortality among people with HIV (PWH). This study aimed to determine the prevalence of self-reported TB disease and identify the demographic, socioeconomic, and clinical factors associated with it among PWH in SSA . Methods We conducted a cross-sectional secondary analysis of data from the Population-based HIV Impact Assessment (PHIA) surveys (2015–2019), including PWH aged ≥15 years from 13 countries in the SSA region. TB status was self-reported, and standardized questionnaires and biomarker data provided demographic, socioeconomic, and clinical covariates. Logistic regression models were applied using survey weights and jackknife variance estimation to identify predictors of HIV/TB co-infection. Results Among 11,663 participants, 31.5% were people with TB. Co-infection prevalence varied widely by country, ranging from 7.5% in Cameroon to 59.5% in Eswatini, with the highest prevalence observed in Southern African countries. Predictors of increased TB risk include older age [Adjusted (aOR): 1.01; 95% CI: 1.00–1.02; p = 0.012], higher wealth quintile (aOR: 1.09; 95% CI: 1.02–1.16; p < 0.01), and longer ART duration (aOR: 1.41; 95% CI: 1.30–1.52; p < 0.001), while protective factors include female sex (aOR: 0.6; 95% CI: 0.51–0.70; p < 0.001), being married or cohabitating (aOR: 0.81; 95% CI: 0.70–0.96; p = 0.01), urban residence (aOR: 0.82; 95% CI: 0.69–0.98; p = 0.028), and a higher CD4-cell count (aOR: 0.999; 95% CI: 0.998–0.9995; p < 0.001). Conclusions HIV/TB co-infection remains highly prevalent in SSA, shaped by demographic, socioeconomic, and clinical factors. Tailored HIV/TB interventions are urgently needed in SSA, prioritizing Southern and Eastern regions and high-risk groups through integrated, community-based, and male-friendly care. Strengthening health systems, improving diagnostics, and addressing social and structural barriers are critical for equitable, sustained progress.