Trends in HIV Status and Treatment Outcomes among Patients with Tuberculosis in Indonesia, 2022–2025: An Analysis of National Surveillance Data

Abstract Background Tuberculosis (TB) and HIV coinfection remain important public health challenges in Indonesia. This study examined demographic characteristics, temporal trends, HIV-status documentation, mortality associations, and provincial spatial patterns among TB registrations during 2022–2025 to inform integrated TB–HIV services. Methods A retrospective analysis used routine surveillance data from Indonesia’s Tuberculosis Information System (SITB). Descriptive analyses assessed demographic and clinical characteristics, treatment outcomes, and annual changes in HIV-status documentation. HIV positivity was calculated among registrations with documented positive or negative HIV status. Logistic regression assessed factors associated with death among eligible registrations from 2022–2024. Sensitivity analyses included modified Poisson regression with robust standard errors, restriction to death versus treatment success, and complete-case analysis. Provincial spatial associations were assessed using Global Moran’s I and local indicators of spatial association, with false discovery rate adjustment for local tests. Results The dataset comprised 2,988,098 TB registrations. Annual registrations increased from 638,646 in 2022 to 827,174 in 2025. The median age was 39 years (interquartile range: 21–55), and 57.6% were male. HIV-status documentation increased from 21.7% to 33.6%, while HIV positivity among registrations with known status declined from 6.3% to 4.7%. Nevertheless, documented HIV-positive registrations increased from 8,735 to 12,980. HIV-positive status was associated with higher odds of death (adjusted odds ratio: 5.06; 95% confidence interval: 4.86–5.26), with a consistent association across sensitivity analyses. Modified Poisson regression yielded an adjusted risk ratio of 4.27 (95% confidence interval: 4.13–4.41). Pooled provincial HIV positivity exhibited significant positive global spatial autocorrelation (Moran’s I = 0.275; P = 0.0029). Annual global associations were significant overall during 2023–2025, but no local associations remained significant after false discovery rate adjustment. Conclusions Increasing TB notifications and documented HIV-positive registrations, persistent gaps in HIV-status documentation, and higher mortality among HIV-positive patients highlight priorities for integrated TB–HIV care. Declining documented positivity should be interpreted cautiously. Strengthening HIV testing, result documentation, coordinated care, and outcome monitoring is essential for informed programme planning.