Research Article

Demographic and Spatial Factors Associated with Tuberculosis and Tuberculosis/Human Immunodeficiency Virus Co-infection in Rivers State, Nigeria

Abstract

Background: Tuberculosis (TB) and TB/HIV co-infection remain major public health challenges in Nigeria, but sub-national determinants and statistically confirmed cluster patterns remain poorly characterised. Objective: To model demographic and spatial factors associated with TB and TB/HIV co-infection case counts, and to identify annual spatial clusters in Rivers State, Nigeria (2019-2024). Methods: Local Government Area (LGA)-level surveillance data were analysed using negative binomial regression with a logpopulation offset. Spatial autocorrelation and year-specific clustering were assessed using Global Moran’s I and Local Indicators of Spatial Association (LISA). Results: Of 87,356 TB and 6,643 TB/HIV cases notified, notification rates peaked among working-age adults (25-44 years: adjusted incidence rate ratio [aIRR] = 2.25 for TB and 17.38 for co-infection), upland topography (aIRR = 1.97 for TB and 4.20 for co infection), and high-density LGAs (aIRR = 2.72 for TB and 5.04 for co-infection). Global Moran’s I was non-significant in all years. Locally, Ahoada West was a persistent Low-Low TB coldspot (2021-2024), while a transient High-High TB/HIV hotspot emerged in the Obio/Akpor, Port Harcourt, and Eleme urban corridor in 2022 only. Conclusion: TB and TB/HIV distributions are independently associated with population density, topography, and age, with effects strongly amplified for co-infection. The stable TB coldspot reflects systemic access barriers, while the transient co-infection hotspot is programme-linked, requiring targeted, year-specific spatial interventions.