Determinants of tuberculosis treatment outcomes among TB/HIV co-infected patients in Gambella refugee camps, Western Ethiopia: a case–control study

Abstract Background TB and HIV co-infection remains a major global public health problem and a leading cause of morbidity and mortality in Ethiopia, one of the 30 high TB/HIV burden countries. Co-infection compromises immune function, thereby increasing the risk of poor treatment outcomes and death. Poor treatment outcome was defined as TB treatment failure, death, or loss to follow-up, in accordance with the national TB program guidelines. This study aimed to identify determinants of poor TB treatment outcomes among TB/HIV co-infected patients in refugee camp settings using medical record data. Methods An unmatched case–control study was conducted among TB/HIV co-infected patients receiving care in refugee camp health facilities in Gambella from January 2022 to January 2025. Cases were patients with poor TB treatment outcomes, while controls were those who achieved successful TB treatment outcomes. A total of 306 participants (153 cases and 153 controls) were selected using simple random sampling. Data were extracted from medical records and analyzed using Stata version 17. Descriptive statistics were used to summarize variables. Bivariable logistic regression was performed to identify candidate variables ( p < 0.25), followed by multivariable logistic regression to identify independent determinants. Both crude odds ratios (COR) and adjusted odds ratios (AOR) with 95% confidence intervals were reported, and statistical significance was declared at p < 0.05. Results Poor TB treatment outcomes were independently associated with having no formal education (AOR = 9.83; 95% CI: 1.75–55.20), being a daily labourer (AOR = 12.27; 95% CI: 3.63–21.06), documented TB drug resistance (AOR = 2.94; 95% CI: 1.38–6.24), and a CD4 count below 200 cells/mm³ (AOR = 3.46; 95% CI: 1.47–8.11). In contrast, good adherence to antiretroviral therapy (ART) was significantly associated with reduced odds of poor treatment outcomes (AOR = 0.16; 95% CI: 0.09–0.30), indicating an 84% reduction in the likelihood of poor outcomes. Conclusion Poor TB treatment outcomes among TB/HIV co-infected patients in refugee camps were significantly associated with low CD4 count, poor ART adherence, TB drug resistance, and educational status. Clinical trial number Not applicable.