Determinants of TB/HIV coinfection-related deaths audited using the TB death checklist from health facilities in Rwanda

INTRODUCTION: Tuberculosis (TB) remains a public health threat worldwide, mainly affecting countries with low-resource settings, including Rwanda. TB/HIV coinfection increases the severity of TB and has a high of resulting in poor outcomes, such as death. This study aims to investigate the actual causes and factors associated with mortality among TB/HIV coinfected patients in Rwanda, to better understand the profile of deaths in this population. METHODS: The retrospective study was conducted nationwide in Rwanda between July 2017 and June 2023, collecting information on TB patients who had died. The data were collected from death audit reports submitted to the National TB Program (NTP) after being filled by healthcare providers at the health facilities. To explore associations between HIV status at the time of TB diagnosis and other variables, bivariate analysis was performed. Multivariate analysis was made to find adjusted odds ratios (AOR), 95% confidence intervals and to assess statistical significance with p-values set at < 0.05. RESULTS: The study examined 1,112 TB death audits. The majority of death audit reports (68.2%) were from men. Among the reported deaths, 70.6% were TB-related. Pulmonary TB smear-negative showed a significantly higher likelihood of being HIV positive (P-value 0.082, aOR 1.97, 95%CI 0.96, 2.12). Individuals who were retreated for TB were likely to be HIV positive compared to the newly diagnosed individuals (P-value <0.007, aOR 2.03, 95%CI 1.22, 3.40). Individuals with severe malnutrition also showed a strong association with TB/HIV coinfection, at P-value 0.002, aOR1.71, 95% CI 1.23, 2.40. CONCLUSION: Individuals who had prior TB infection and pulmonary TB with smear-negative results showed a higher likelihood of having HIV coinfection, highlighting a need for regular screening by using rapid and accurate TB diagnostic tools, specifically among PLHIV.