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. 2025 Apr 16;25(3):e3042.
doi: 10.5867/medwave.2025.03.3042.

Sociodemographic and spatiotemporal distribution of tuberculosis and human immunodeficiency virus co-infection in three cantons of Guayas, Ecuador: A cross-sectional study

Ronald Cedeño Vega  1 , Inti Kory Quevedo  1 , Jaime Angamarca-Iguago  1   2 , Jaen Carlos Cagua-Ordoñez  1   2 , Juan Marcos Parise-Vasco  1   2 , Daniel Simancas-Racines  1   2
Affiliations

Sociodemographic and spatiotemporal distribution of tuberculosis and human immunodeficiency virus co-infection in three cantons of Guayas, Ecuador: A cross-sectional study

Ronald Cedeño Vega et al. Medwave. .

Abstract
in English, Spanish

Introduction: Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection are major public health problems in Latin America and Africa. The province of Guayas in Ecuador has a high proportion of cases but there is limited information on their sociodemographic characteristics and spatial distribution. The aim of this study was to analyze the sociodemographic and spatiotemporal characteristics of TB/HIV coinfection patients in three cantons of the Guayas province, Ecuador, in 2018.

Methods: A cross-sectional study was conducted using secondary data from the Ministry of Public Health of Ecuador. The study population was all adult patients with a diagnosis of TB/HIV co-infection residing in the three cantons of the three cantons. Data were analyzed to determine prevalence, incidence and mortality, as well as socio-demographic variables such as age, sex, educational level and housing conditions. Spatial distribution was assessed using QGIS software version 3.24 to identify high-prevalence areas.

Results: A total of 379 cases of TB/HIV coinfection were identified, with a predominance of males (80.74%) and a mean age of 35 years. The prevalence was 1.24 per 100 000 inhabitants, with a case fatality rate of 15.57%. Individuals below the poverty line showed a stronger association with co-infection (PR=6.773, 95% CI: 4.985 to 9.202). Spatially, cases were concentrated in socioeconomically disadvantaged municipalities of Guayaquil.

Conclusions: TB/HIV co-infection shows a clear association with social determinants, especially poverty and educational level. The heterogeneous spatial distribution among the three cantons and the high case fatality rate suggests the need to strengthen epidemiological surveillance and implement targeted interventions addressing social determinants in the most vulnerable areas.

Introducción: La coinfección de tuberculosis (TB) y virus de inmunodeficiencia humana (VIH) representa un importante problema de salud pública en América Latina y en África. La provincia de Guayas en Ecuador concentra una alta proporción de casos, sin embargo, existe limitada información sobre sus características sociodemográficas y distribución espacial. El objetivo de este estudio fue analizar las características sociodemográficas y espaciotemporales de pacientes con la coinfección de TB/VIH en tres cantones de la provincia de Guayas en Ecuador durante el año 2018.

Métodos: Se realizó un estudio transversal utilizando datos secundarios del Ministerio de Salud Pública del Ecuador. La población de estudio fueron todos los pacientes adultos con diagnóstico de coinfección de TB/VIH con residencia en los tres cantones. Se analizaron los datos para determinar prevalencia, incidencia y mortalidad, además de variables sociodemográficas como edad, sexo, nivel educativo y condiciones de vivienda. La distribución espacial se evaluó mediante sistemas de información geográfica QGIS versión 3.24 para identificar áreas de alta prevalencia.

Resultados: Se identificaron 379 casos de coinfección TB/VIH, con predominio masculino (80.74%) y edad media de 35 años. La prevalencia fue 1.24/100,000 habitantes, con una letalidad de 15.57%. Las personas bajo la línea de pobreza presentaron mayor asociación con la coinfección (RP=6.773, IC95%: 4.985 a 9.202). Espacialmente, los casos se concentraron en parroquias socioeconómicamente vulnerables de Guayaquil.

Conclusiones: La coinfección TB/VIH muestra una clara asociación con determinantes sociales, particularmente pobreza y nivel educativo. La distribución espacial heterogénea entre los tres cantones, y la alta letalidad sugieren la necesidad de fortalecer la vigilancia epidemiológica e implementar intervenciones territorializadas que aborden los determinantes sociales en áreas de mayor vulnerabilidad.

Keywords: Coinfection; HIV infections; poverty; social determinants of health. (MeSH); tuberculosis.

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Conflict of interest statement

The authors declare no conflicts of interest related to this manuscript.

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