Increased uptake of tuberculosis preventive therapy (TPT) among people living with HIV following the 100-days accelerated campaign: A retrospective review of routinely collected data at six urban public health facilities in Uganda

Abstract

IntroductionTuberculosis preventive therapy (TPT) effectively decreases rates of tuberculosis reactivation in people living with HIV (PLHIV) who are at increased risk. The Uganda Ministry of Health launched a 100-day campaign to scale-up TPT in PLHIV in July 2019. We sought to examine the effect of the campaign on trends of TPT uptake and characteristics associated with TPT uptake and TPT completion among persons in HIV care. We retrospectively reviewed routinely collected data from 2016 to 2019 at six urban public health facilities in Uganda.MethodsA cross-sectional review of the HIV care database and paper-based TPT registers at six public health facilities in Kampala, Uganda. Estimated trends of prevalence of TPT (given as Isoniazid preventive therapy [IPT]) uptake and treatment completion across the 4 years, among PLHIV aged 15 years and above, and factors associated, were examined using Poisson regression model with robust standard errors using generalized estimating equation (GEE) models.ResultsOn average a total of 43,215 patients aged 15 years and above were eligible for TPT each calendar year at the six health facilities. More than 70% were females and median age was 34 years (inter-quartile range 28 to 41 years on overall). There was consistently low TPT uptake from 2016 to 2018, but as expected, the uptake significantly increased by about 25% (relative increase) from 2.5% of eligible PLHIV in 2018 to 64.8% in 2019 (prevalence of TPT uptake 4.5% (1,746/38,704), 4.4% (1,743/39,630), 2.5% (1,018/40,390), and 64.8% (26,478/40,867) during 2016, 2017, 2018 and 2019 respectively). TPT uptake in 2019 was 26.0 times higher compared to that in 2018 (adjusted prevalence ratio [aPR] = 26.0 [95%CI 24.5, 27.7], P-value<0.001). Also, TPT completion was consistently high at about 80% between years 2016 – 2018 but dramatically increased by 17% (relative increase) in 2019 compared to that in 2018 (prevalence of TPT completion was 81.2%, 76.3%, 82.6% and 96.5% in year 2016, 2017, 2018 and 2019 respectively). The increase in TPT completion prevalence from 2018 to 2019 remained significant even after adjusting for patients’ baseline characteristics (aPR [95%CI] = 1.12 [1.04, 1.21], P value=0.003). Not on ART or newly started on ART compared ART experienced were associated with poor TPT completion, whereas older age (≥25 years versus 15-24 years) was associated with higher TPT completion.ConclusionThe targeted 100-day campaign dramatically increased TPT uptake and completion among PLHIV suggesting a viable catch up strategy to meet WHO guidelines.

Preventing tuberculosis with community‐based care in an HIV‐endemic setting: a modelling analysis

“…First, we assumed that the modelled care programmes could take effect immediately and be sustained over 10 years, which may not be feasible for an already‐strained healthcare workforce and budgets. However, dramatic increases in TPT initiation and completion have been observed in some HIV high‐incidence settings through focused outreach campaigns [70]. Second, following calibration, the protective effect of ART compared to TPT was amplified, such that our model estimated a somewhat greater impact of ART and a somewhat lower impact of TPT on TB relative to our target values [11, 34].…”