Risk Factors for Recurrent Tuberculosis among Patients on Anti-Retroviral Treatment in Rural Northeast South Africa: Findings from clinic records in the Agincourt sub-district

Introduction Tuberculosis (TB) remains a major global health concern, particularly among HIV-infected individuals. Recurrent TB contributes significantly to the TB burden, especially in high-prevalence areas. In this study, we determined the incidence rate of recurrent TB and investigated the risk-factors for recurrence of TB among HIV-infected people on Anti-retroviral treatment in the rural Agincourt sub-district in Mpumalanga Province, South Africa. Methods A retrospective cohort study was conducted using clinic data linked to the Agincourt Health and Socio-Demographic Surveillance System (HDSS) from January 2014 to December 2022. Cox regression was used to determine risk factors for recurrent TB. Results Among 4,803 patients, 396 (8.2%) experienced recurrent TB, with a recurrence rate of 3.0 per 100 person-years. Time to recurrence ranged from 7 days to 8.66 years, with a median of 1.93 years. Significant risk factors included being male (aHR = 1.48, CI: 1.11–1.96), WHO HIV stage (aHR = 2.53, CI: 1.81–3.54), baseline CD4 count ≤ 185 cells/mm³ (aHR = 0.98, CI: 0.98–0.99), and prior TB treatment duration > 6 months (aHR = 0.96, CI: 0.93–0.98). Conclusion Findings highlight the need for targeted interventions for males, early HIV diagnosis, improved CD4 maintenance, and continuous TB monitoring during and post-treatment to reduce recurrence risk.