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. 2025 May 22;25(1):1882.
doi: 10.1186/s12889-025-23090-8.

Incidence and risk factors for tuberculosis at a rural HIV clinic in Uganda, 2012-2019; A retrospective cohort study

Ibrahim Sendagire  1 , Victor Ssempijja  2   3 , Anthony Ndyanabo  2 , Absalom Ssettuba  2 , Annie N Mawanda  2 , Gertrude Nakigozi  2 , Deus Lukoye  4 , Arthur G Fitzmaurice  4 , Richard Muhindo  5 , Stella Zawedde-Muyanja  6 , Steven J Reynolds  7   8
Affiliations

Incidence and risk factors for tuberculosis at a rural HIV clinic in Uganda, 2012-2019; A retrospective cohort study

Ibrahim Sendagire et al. BMC Public Health. .

Abstract

Background: Tuberculosis (TB) is the leading cause of death among people living with HIV (PLHIV). Antiretroviral therapy (ART) initiation lowers the risk of HIV-associated TB. Earlier studies have shown TB incidence to be high in the first year of ART. We undertook a study to (1) assess the incidence of TB and (2) associated factors among persons initiating ART in a rural cohort.

Methods: We conducted a retrospective cohort analysis study among PLHIV aged ≥ 18 years, initiated on ART from January 1, 2012, to December 31, 2019, and TB disease-free at the time of ART initiation, at Kalisizo ART clinic. TB disease incidence was calculated by dividing the number of new TB cases by the total follow-up time expressed per 100 person-years among persons followed up until the date of incident TB disease, loss to follow-up, transfer out, death or censored at the end of the study; whichever occurred first. Factors associated with TB disease incidence were assessed in the multivariable analysis by Poisson regression analysis at 5% significance level.

Results: For the period 2012 to 2019, 2,589 PLHIV were initiated on ART; 57% (1,470/2,589) were female. Females were more likely to be aged below 35 years while males were more likely to be aged 25-44 years (p < 0.001). Eighty-seven per cent (1,269/1,470) of females compared to 78% (866/1,119) of males were in WHO clinical stage 1 (p < 0.001). Sixty-one TB disease events were observed in 7,363 person-years. The overall TB disease incidence was 0.83 (95% CI: 0.63-1.06) per 100 person-years. Males were more likely than females to develop TB disease, adjusted incidence rate ratio (adj IRR) 2.13 (95% CI: 1.27-3.57) per 100 person-years, p = 0.004. Compared to using ART for 0-5 months, time on ART was associated with a lower TB incidence rate at 6-12 months, 13-24 months, > 24 months (adj IRR 0.20 (95% CI: 0.09-0.46), 0.14 (95% CI: 0.06-0.33), 0.16 (95% CI: 0.08-0.31) p < 0.001 respectively).

Conclusions and recommendations: Incidence of TB among PLHIV on ART was low in this rural population. Clinicians offering care to people with HIV in the rural setting should have a heightened index of suspicion for TB disease.

Keywords: Africa; TB; TB incidence during ART; TB/HIV prevalence; Tuberculosis; Tuberculosis in HIV patients; Tuberculosis in rural areas.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This activity of analyzing retrospective PEPFAR program data was reviewed, the need for consent to participate waived, and approved by the Uganda Virus Research Institute, Research and Ethics Committee (reference no. GC/127/19/05/654). This activity was also reviewed by CDC, deemed research not involving human subjects, and was conducted consistent with applicable federal law and CDC policy. The Research was cleared by the Uganda National Council for Science and Technology (reference no. SS334ES). Permission to access the data was obtained from the RHSP administration. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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