Regional disparities of TB-HIV coinfection among national health insurance members in Indonesia

<h2>Abstract</h2><h3>Problem Considered</h3> TB-HIV coinfection <b>remains</b> a significant public health issue in Indonesia, with the National Health Insurance (NHI) playing a key role in its management. Although Indonesia is divided into seven major regions, available coinfection data are typically reported only at the national level or for selected provinces. This study aims to examine regional disparities in TB-HIV coinfection among NHI members. <h3>Methods</h3> A secondary analysis was conducted using 2023 Indonesian NHI data comprising 39,635 TB patients aged 25-49 years. The relationship between TB-HIV coinfection and geographic region was assessed, controlling for sex, age, marital status, and NHI membership class. Binary logistic regression was applied to estimate adjusted odds ratios (aOR) with 95% confidence intervals. <h3>Results</h3> The national prevalence of TB-HIV coinfection was 4.6%. Substantial disparities were identified across regions. Papua exhibited the highest risk, with patients 4.702 times more likely to have coinfection compared to Sumatra (95% CI: 4.297-5.144), followed by Maluku at 1.824 times (95% CI: 1.539-2.161). In contrast, Sulawesi showed the lowest risk at 0.713 times compared to Sumatra (95% CI: 0.651-0.780). These results confirm significant regional variation in TB-HIV coinfection among NHI members. <h3>Conclusions</h3> This study shows that TB-HIV coinfection in Indonesia is disproportionately concentrated in regions with unique geographic and demographic characteristics, particularly Papua and Maluku. These findings emphasize the importance of utilizing subnational data to design geographically targeted interventions. Furthermore, this research can provide valuable insights for other countries with heterogeneous populations and diverse geographic conditions facing similar dual epidemics.