{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:51:44Z","timestamp":1787010704142,"version":"build-2736575974"},"posted":{"date-parts":[[2025,11,28]]},"group-title":"HIV\/AIDS","reference-count":30,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,11,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>\n                  Botswana implemented its universal \u201cTreat All\u201d antiretroviral therapy (ART) policy in 2016, expanding treatment eligibility to all people living with HIV (PLHIV). HIV has been known to be a leading risk factor for tuberculosis (TB) and poor TB treatment outcomes. The primary goal of this study is to assess whether HIV infection and HIV-associated immunosuppression remain risk factors for unfavorable TB treatment outcomes in the Post\u2013Treat All era. We analyzed 636 TB patients treated in Gaborone (2017\u20132023), of whom 54.4% were HIV-positive. Unfavorable outcomes (death, failure, or loss to follow-up) occurred in 19.7% of HIV-positive and 8.5% of HIV-negative patients. We used logistic regression to estimate unadjusted and covariate-adjusted associations between TB treatment outcome and HIV status and between TB treatment outcome and CD4+ T-cell count. HIV-positive patients had 2.5-fold higher odds of unfavorable outcomes compared with HIV-negative patients [adjusted OR: 2.51, 95% CI: (1.48, 4.38)], controlling for age, sex, TB history, distance to clinic, substance use, and occupational status. PLHIV with CD4+ T-cell &lt; 200 cells\/\n                  <jats:italic>\u00b5<\/jats:italic>\n                  L was associated with approximately three-fold higher odds of unfavorable outcomes compared with HIV-negative participants [OR: 3.12, 95% CI: (1.65, 5.97)]. The secondary goal was to test whether the HIV effect changed following Treat All implementation. We combined the data from 2017\u20132023 with a Pre\u2013Treat All cohort (2012\u20132016, n= 233, HIV prevalence 60.8%) and fit a frequentist logistic regression and Bayesian mixed-effects models with an interaction term that allows treatment era (Pre- vs. Post-Treat All) to modify the effect of HIV on TB treatment outcome. The estimated change in the HIV effect was uncertain [relative OR: 0.41; 95% CI: (0.11, 1.55)]. Combining the two Botswana data sets with 12 Pre- and Post-Treat All studies from neighboring Ethiopia showed that the pooled effect of HIV infection on unfavorable TB outcome has increased in the Post-Treat All period [relative OR: 2.39; 95% BCI: (1.36, 3.34)].\n                <\/jats:p>","DOI":"10.1101\/2025.11.26.25340699","type":"posted-content","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T19:05:19Z","timestamp":1764356719000},"source":"Crossref","is-referenced-by-count":1,"title":["HIV Remains a Risk Factor for Unfavorable Tuberculosis Treatment Outcomes in the Era of Universal Access to Antiretroviral Therapy in Botswana"],"prefix":"10.64898","author":[{"given":"Azadeh","family":"Baniasad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siheng","family":"Chao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chawanga","family":"Modongo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1917-9288","authenticated-orcid":false,"given":"Volodymyr M.","family":"Minin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessalyn N.","family":"Sebastian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9982-4373","authenticated-orcid":false,"given":"Sanghyuk S.","family":"Shin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2025120101250667000_2025.11.26.25340699v1.1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(16)30037-0"},{"key":"2025120101250667000_2025.11.26.25340699v1.2","doi-asserted-by":"publisher","DOI":"10.5696\/2156-9614-7.15.71"},{"key":"2025120101250667000_2025.11.26.25340699v1.3","doi-asserted-by":"crossref","first-page":"100279","DOI":"10.1016\/j.jctube.2021.100279","article-title":"Impact of hiv-aids on tuberculosis treatment outcome in southern ethiopia\u2013a retrospective cohort study","volume":"25","year":"2021","journal-title":"Journal of clinical tuberculosis and other mycobacterial diseases"},{"issue":"194","key":"2025120101250667000_2025.11.26.25340699v1.4","first-page":"1","article-title":"Treatment outcome of tuberculosis in selected health facilities of gedeo zone, southern ethiopia: A retrospective study","volume":"5","year":"2015","journal-title":"Mycobact Dis"},{"key":"2025120101250667000_2025.11.26.25340699v1.5","doi-asserted-by":"publisher","DOI":"10.1016\/S2666-5247(22)00359-7"},{"key":"2025120101250667000_2025.11.26.25340699v1.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2022.e11527"},{"key":"2025120101250667000_2025.11.26.25340699v1.7","doi-asserted-by":"crossref","unstructured":"Ayenew Berhan , Andargachew Almaw , Yenealem Solomon , Biruk Legese , Shewaneh Damtie , Mulat Erkihun , Zewuditu Alebachew , Tahir Eyayu , Getu Abeje , and Birhanu Getie . Tuberculosis treatment outcome and associated factors among tuberculosis patients linked to tuberculosis treatment clinics in ethiopia, 2023: a multi\u2013center retrospective study. Infection and Drug Resistance, pages 3367\u20133378, 2023.","DOI":"10.2147\/IDR.S413272"},{"issue":"1","key":"2025120101250667000_2025.11.26.25340699v1.8","first-page":"8504629","article-title":"Treatment outcomes of tuberculosis and associated factors in an ethiopian university hospital","volume":"2016","year":"2016","journal-title":"Advances in Public Health"},{"key":"2025120101250667000_2025.11.26.25340699v1.9","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofae466"},{"key":"2025120101250667000_2025.11.26.25340699v1.10","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v100.i05"},{"key":"2025120101250667000_2025.11.26.25340699v1.11","unstructured":"Centers for Disease Control and Prevention. HIV and TB Overview: Botswana. https:\/\/www.cdc.gov\/global-hiv-tb\/php\/where-we-work\/botswana.html, 2025. Accessed: 2025-08-06; content indicates \u201cJune 30, 2025\u201d."},{"issue":"1","key":"2025120101250667000_2025.11.26.25340699v1.12","doi-asserted-by":"crossref","first-page":"4212312","DOI":"10.1155\/2023\/4212312","article-title":"Tuberculosis treatment outcomes and its predictors among tuberculosis patients registered at tefera hailu memorial general hospital, sekota town, northeast ethiopia: A seven-year retrospective study","volume":"2023","year":"2023","journal-title":"Canadian Journal of Infectious Diseases and Medical Microbiology"},{"issue":"1","key":"2025120101250667000_2025.11.26.25340699v1.13","doi-asserted-by":"crossref","first-page":"29281","DOI":"10.1038\/s41598-024-78084-0","article-title":"Determinants of an unfavorable treatment outcome among tuberculosis patients in the jimma zone, southwest ethiopia","volume":"14","year":"2024","journal-title":"Scientific Reports"},{"key":"2025120101250667000_2025.11.26.25340699v1.14","unstructured":"Centers for Disease Control and Prevention. 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