Clinical Characteristics and Treatment Outcomes among Tuberculosis and TB-HIV Coinfected Patients at Tertiary Health Care Center, South Gujarat, India: A Mixed-method Study.

Background: Human immunodeficiency virus-tuberculosis coinfection represents a major public health problem, especially in resource-poor countries like India. This mixed-method study explores the epidemiological and clinical characteristics, including treatment outcomes of HIV-TB coinfected patients, as compared to TB cases alone. Material and Methods: The quantitative phase had a case-control study design wherein information from 314 patients was extracted between January 2019 and December 2020 in the Anti-retroviral Therapy Center and District Tuberculosis Centre, Surat, India. The qualitative phase, through in-depth interviews with health workers, identified challenges faced by HIV/TB patients, which usually include stigma, unawareness, and logistical problems, which impede treatment adherence and success. Results: Key findings included a significantly higher rate of unsuccessful treatment outcomes among HIV-TB coinfected patients than that of TB-only patients, with mortality and loss to follow-up contributing largely. Early initiation of TB therapy, socioeconomic status, and microbiological confirmation were seen to be positively associated with the success of tuberculosis treatment. Most importantly, it was identified from this study that coinfected patients had lower treatment adherence rates, which are associated with poor outcomes, for which targeted interventions may be required. Conclusion: The findings highlight the need for integrated care approaches that focus on clinical and socioeconomic factors. They also indicate areas where support structures can be improved for healthcare providers. This study calls for better strategies toward improving treatment adherence and outcomes among HIV-TB coinfected people to meet the various challenges they confront.