Double Burden of Tuberculosis-HIV Co-infection and Drug Resistance in the Post-Conflict Far-North Region of Cameroon

In Cameroon, the Far-north region counts as one of the ten regions that lacks data’s concerning tuberculosis dynamics. Subject to national insecurity few years ago, some of the direct consequences include promiscuity, poverty, under diagnosis, treatment absence, leading to high burden of tuberculosis (TB). The present research was conducted across the Far-North Region of Cameroon for the first time, to investigate pulmonary tuberculosis among affected TB patients. Sputum specimens were collected following a rigorous questionnaire‑based investigation and HIV screening test. The specimens were subjected to microscopic examination, followed by culture. Strains of M. tuberculosis (MTB) complex isolated were tested for susceptibility to antibiotics and molecular detection of drug resistance (DR) was performed with MTB/DRplus. Between May 2022 to December 2025, 213 questionnaires were administered to randomly selected participants at the Maroua Regional Hospital, Mokolo and Koza District Hospitals, Koza Adventist Hospital and Minawao Health Center. Among these included participants, 146 of the 191 sputum samples were confirmed positive for M. tuberculosis complex, yielding a TB positivity rate of 76.4%. HIV seroprevalence of 13.6%, was noted and TB-HIV co-infection rate was 9.9%. Tuberculosis was significantly associated to male sex (p = 0.007), urban residence (p = 0.049), occupational activity primarily in the agricultural sector (p = 0.021) and infection status (p<0.001). 40 randomly selected culture-positive LJ strains of MTBC were subjected to the GenoType MTBDRplus test. While 80% of these strains were susceptible to both rifampicin and isoniazid, 20% exhibited at least one resistance with 7.5% classified as rifampicin monoresistance, 5% isoniazid monoresistance and 7.5% multi-resistant to both drugs. The mutation associated with rifampicin resistance was D516V in rpo B gene. for isoniazid resistance, mutation was identified at kat G gene (S315T) and the inh A promoter region (C-15T and A-16G). These findings underscore the need to target sociodemographic determinants of TB in healthcare access and diagnostic delay (male sex, rural residence, agricultural occupation, infection status). The lack of association between HIV status and smear positivity, combined with the well-established risk of paucibacillary disease in HIV-positive individuals, represents an important limitation to acknowledge, and supports advocating need for the use of more sensitive conventional and molecular diagnostics interventions (e.g., Xpert MTB/RIF, LPA) in HIV-positive presumptive TB cases in this setting.