Trends in Bidirectional Screening and Treatment Outcomes for Tuberculosis/HIV Comorbidity - China, 2020-2024

The comorbidity of tuberculosis (TB) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) represents a persistent global public health challenge. This study examines the epidemiological trends of TB/HIV comorbidity in China during 2020-2024, extending previous analyses from the 2015-2019 period.

We collected annual TB/HIV comorbidity surveillance data from 32 provincial-level administrative divisions (PLADs) in China, encompassing bidirectional screening protocols, treatment initiation rates, and clinical outcomes. TB screening among people living with HIV (PLHIV) incorporated systematic symptom assessment and chest X-ray or sputum examination. HIV testing for TB patients employed standard serological methodologies. We performed statistical analyses and generated spatial distribution maps using R 4.2.1.

During 2020-2024, 5,970,062 PLHIV were registered nationwide, with TB examination coverage increasing significantly from 90.2% (957,844/1,061,665) to 94.3% (1,246,274/1,321,458) (P<0.01). The overall TB detection rate among PLHIV was 0.5% (27,991/5,506,876). Among 2,843,159 registered TB patients, HIV testing coverage rose from 67.1% (419,332/625,395) to 68.7% (375,488/546,386) (P<0.01), yielding an overall HIV positivity rate of 1.1% (22,030/1,937,418). We identified 31,783 TB/HIV comorbid patients, of whom 70.9% (21,139/29,836) received concurrent antiretroviral therapy (ART) and anti-TB treatment. Treatment success rates declined significantly from 88.6% (9,521/10,751) in 2020 to 82.9% (3,743/4,513) in 2024 (P<0.01), while mortality rate increased from 4.8% (515/10,751) to 8.8% (398/4,513) (P<0.01).

Although bidirectional screening coverage has improved, substantial regional disparities persist alongside concerning trends of declining treatment success rates and increasing mortality. Enhanced implementation of efficient diagnostic technologies, optimized treatment protocols, and comprehensive stigma reduction initiatives are essential to improve survival outcomes for TB/HIV comorbid patients.