Sociodemographic and spatiotemporal distribution of tuberculosis and human immunodeficiency virus co-infection in three cantons of Guayas, Ecuador: A crosssectional study.

INTRODUCTION Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection are major public health problems in Latin America and Africa. The province of Guayas in Ecuador has a high proportion of cases but there is limited information on their sociodemographic characteristics and spatial distribution. The aim of this study was to analyze the sociodemographic and spatiotemporal characteristics of TB/HIV coinfection patients in three cantons of the Guayas province, Ecuador, in 2018. METHODS A cross-sectional study was conducted using secondary data from the Ministry of Public Health of Ecuador. The study population was all adult patients with a diagnosis of TB/HIV co-infection residing in the three cantons of the three cantons. Data were analyzed to determine prevalence, incidence and mortality, as well as socio-demographic variables such as age, sex, educational level and housing conditions. Spatial distribution was assessed using QGIS software version 3.24 to identify high-prevalence areas. RESULTS A total of 379 cases of TB/HIV coinfection were identified, with a predominance of males (80.74%) and a mean age of 35 years. The prevalence was 1.24 per 100 000 inhabitants, with a case fatality rate of 15.57%. Individuals below the poverty line showed a stronger association with co-infection (PR=6.773, 95% CI: 4.985 to 9.202). Spatially, cases were concentrated in socioeconomically disadvantaged municipalities of Guayaquil. CONCLUSIONS TB/HIV co-infection shows a clear association with social determinants, especially poverty and educational level. The heterogeneous spatial distribution among the three cantons and the high case fatality rate suggests the need to strengthen epidemiological surveillance and implement targeted interventions addressing social determinants in the most vulnerable areas.