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Liangshan Yi Autonomous Prefecture in Southwest China bears a dual high burden of HIV and TB. This study aimed to analyze the epidemiological trends of HIV-TB co-infection in Liangshan from 2019 to 2024 and to inform integrated prevention strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted on 3367 HIV-TB co-infected cases extracted from the National HIV\/AIDS and TB surveillance systems. Records were linked via unique identifiers. Descriptive statistics and chi-square tests for trend assessed incidence trends, demographics, transmission routes, treatment outcomes, and drug resistance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From 2019 to 2024, HIV-TB incidence declined from 12.26 to 8.76 per 100,000 (\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      <jats:sub>trend<\/jats:sub>\n                      \u2009=\u200940.459,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), driven by high-burden counties and populations under 45\u00a0years (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Patients were predominantly young males (61.10%) and farmers (92.37%). The main HIV transmission routes were heterosexual contact (48.29%) and injection drug use (41.31%), with marked sex and age disparities: injection drug use predominated in males (50.92%) and those aged 30 \u2013\u2009&lt;\u200945\u00a0years (50.32%), while heterosexual transmission prevailed in females (77.07%) and older adults (\u2265\u200960\u00a0years, 87.62%). Treatment success rate was 81.76%, significantly lower in the elderly (69.52%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). Any drug resistance (3.30%) increased from 1.54% to 3.10% (\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      <jats:sub>trend<\/jats:sub>\n                      \u2009=\u20098.481,\n                      <jats:italic>P<\/jats:italic>\n                      <jats:sub>trend<\/jats:sub>\n                      \u2009=\u20090.004).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      During the implementation of integrated strategies, HIV-TB incidence showed a declining trend, particularly in high-burden areas and younger populations. Persistent challenges\u2014stagnant incidence and poor outcomes in the elderly, high loss to follow-up (10.87%), rising drug resistance\u2014require targeted interventions: leveraging the Yi \u201cclan\u201d (\n                      <jats:italic>Jiazhi<\/jats:italic>\n                      ) system, strengthening active screening and nutritional support for older adults, optimizing drug resistance surveillance, and integrating digital health tools.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40249-026-01495-w","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T03:56:25Z","timestamp":1788494185000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["HIV-tuberculosis co-infection in Liangshan, a resource-limited region of Southwest China: trends and implications in the context of integrated prevention, 2019\u20132024"],"prefix":"10.1186","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5845-3130","authenticated-orcid":false,"given":"Xuefei","family":"Bai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2588-6977","authenticated-orcid":false,"given":"Ju","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinhong","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7615-360X","authenticated-orcid":false,"given":"Sisi","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruobing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yubing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoying","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2876-901X","authenticated-orcid":false,"given":"Rong","family":"Pei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8528-0846","authenticated-orcid":false,"given":"Rujun","family":"Liao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"1495_CR1","volume-title":"Global tuberculosis report 2025","author":"World Health Organization","year":"2025","unstructured":"World Health Organization. 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