Determinants and Health Systems Implications of Human Immunodeficiency Virus and Tuberculosis Co-Infection Treatment Outcomes in Homa Bay County, Kenya

Background:  End Tuberculosis (TB) Strategy’s global goal aims to reduce tuberculosis deaths by 90% and cases by 80% by 2030. Understanding this strategy implementation and the current status of health systems’ capacity is essential for planning effective response interventions. While Kenya’s progress toward the global tuberculosis targets is at 84%, it’s important to clarify what performance means for service delivery capacity, more so in high-burden regions like Homa Bay County. Objective: To determine factors and effects influencing HIV and TB co-infection on health systems management in Homa Bay County, Kenya. Design.  Cross-sectional convergent mixed-methods study. Settings: Twenty-five level four health facilities. Subjects:  Two hundred and forty- five HIV/TB Co-infections as participants. Results: The mean age of participants was 41.1+/-12.5 years; median (IQR) of 40.0 (IQR 32–49). Overall,42.04% (n=103) were married, 35.51% (n=87) widowed, and 11.43% (n=28); 50.2% (n=123) were females, while 74.29% (n=182) were rural residents. Patients with known treatment outcomes were 48.16% (n=118), and 33.06% (n=81) were still on treatment. AFB-positive sputum (AOR = 2.2, 95% CI: 1.2–4.3, p = 0.014) and extra-pulmonary TB (AOR = 2.8, 95% CI: 1.3–6.1, p = 0.008) were significantly associated with increased odds for adverse outcomes. Protective factors included integrated HIV/TB services (AOR = 0.21,95%CI: 0.09-0.49, p =< 0.001) and hospital admission during the intensive phase (chi2 = 43.91, p < 0.001) showed the strongest single binary association. Identified themes were patient satisfaction with care, access barriers, stock-out reports, and low laboratory tests. Conclusion: The persistent gap between current treatment performance and End TB Strategy targets reflects unresolved health system management weaknesses rather than purely biomedical shortcomings. Therefore, building a health system that gives every co-infected patient in Homa Bay a genuine and equal chance of completing treatment successfully is key.