Abstract
Background: Pulmonary tuberculosis (PTB) remains a significant public health challenge in Nigeria, particularly in regions with high HIV prevalence. Benue State has one of the highest HIV prevalence rates in Nigeria, yet local epidemiological data on TB from secondary healthcare facilities in the state remain sparse. This study aimed to determine the detection rate of Mycobacterium tuberculosis, rifampicin resistance profiles stratified by treatment history, and HIV co-infection rates among presumptive TB patients presenting at a secondary healthcare facility in Gboko, Benue State, Nigeria.
Methods: A prospective hospital-based cross-sectional study was conducted from January to June 2019 at Gboko General Hospital, a secondary healthcare facility in Gboko Local Government Area of Benue State. A total of 296 consecutive patients referred for PTB diagnosis were enrolled. Sputum samples were analyzed using Ziehl-Neelsen acid-fast bacilli (AFB) smear microscopy and the Cepheid GeneXpert MTB/RIF molecular assay. HIV serostatus was determined using rapid diagnostic tests according to the national testing algorithm. Statistical analysis included chi-square tests, binary logistic regression, calculation of proportions with 95% confidence intervals using the Wilson score method, and descriptive statistics. Significance was set at p < 0.05.
Results: The overall MTB detection rate among presumptive TB patients was 18.2% (54/296, 95% CI: 14.3–23.0%). HIV seroprevalence among the study population was 27.0% (80/296, 95% CI: 22.3–32.4%). Rifampicin resistance was detected in 18.5% of MTB-positive cases (10/54), with a rate of 13.0% (6/46) among new cases and 50.0% (4/8) among previously treated cases. The HIV/MTB co-infection rate was 4.4% (13/296, 95% CI: 2.6–7.4%). The mean age of patients was 30 years (SD: 14.2), with the highest burden observed in the 31–40 year age group (24.1% of MTB-positive cases). No statistically significant association was found between TB detection and HIV status (χ² = 0.36, df = 1, p = 0.55; OR = 0.84, 95% CI: 0.43–1.66). No significant sex difference was observed in TB detection (χ² = 1.85, df = 1, p = 0.174).
Conclusions: This study demonstrates a substantial burden of pulmonary tuberculosis among presumptive TB patients in Gboko, with a notably higher rifampicin resistance rate among previously treated patients (50.0%) compared to new cases (13.0%). The findings underscore the need for stratified drug resistance surveillance, strengthened diagnostic capacity including culture confirmation, and integrated TB/HIV services in this high-burden region.

Key words: Pulmonary tuberculosis, Mycobacterium tuberculosis, HIV co-infection, rifampicin resistance, GeneXpert MTB/RIF, Nigeria, epidemiology