Determinants of Positive Tuberculosis Screening among People Living with HIV in Eswatini: A Retrospective Analysis
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Abstract
Tuberculosis (TB) remains a leading cause of death among people living with human immunodeficiency virus (PLHIV), even though it is preventable and curable. The World Health Organisation (WHO) recommends routine TB screening for PLHIV using the WHO four-symptom screen (cough, fever, night sweats, nd weight loss). Therefore, this study investigated the factors influencing TB spread and risk in Eswatini, focusing on age, gender, and clinical factors. We nalysed 84,388 PLHIV patient records (2018-2022), and multivariate logistic regression was used to examine the association between TB screening results and various sociodemographic and clinical factors. The results indicated that older age was significantly associated with positive TB screening results (p < 0.05). Men are less likely than women to test positive (β = -0.08; 95% CI: -0.26, 0.10). Children are about twice as likely to have positive results compared to adults (β = 2.08; 95% CI: 1.54, 2.63). Clinical symptoms such as chest pain (β = 5.61; 95% CI: 5.23, 6.00) and fever (β = 5.14; 95% CI: 4.75, 5.53) were strongly associated with positive TB results. Patients on antiretroviral therapy (ART) for HIV were also ess likely to have positive TB screening results (β = -0.36; 95% CI: -0.68, -0.05). In conclusion, this study emphasises the importance of timely TB identification and treatment among PLHIV. Targeted interventions are vital for reducing TB transmission and mortality and achieving the 2030 global targets. The findings highlight the continued epidemiological importance of TB/HIV co-infection and demonstrate that demographic characteristics, clinical symptoms, and treatment- related factors significantly influence TB screening outcomes in PLHIV. These findings reinforce the relevance of the WHO-recommended symptom-based screening approach in settings with a high TB burden.
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