Tuberculosis (TB) preventive treatment (TPT) has been shown to drastically reduce mortality among people living with HIV (PLHIV). The World Health Organization recommends TPT for all PLHIV without contraindications or active TB disease. Accordingly, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is committed to providing TPT to the eligible 14 million PLHIV currently supported by this program. In 2017, PEPFAR-supported programs began biannual reporting on TPT among all new and existing antiretroviral (ART) patients.
We conducted a descriptive analysis of TPT completions and expected completions (i.e. those initiated on TPT in the previous six-month reporting period) in PEPFAR-supported sites during 2017–2019. Countries with >90% TPT data completion were included for analysis. We calculated the proportion of PLHIV who completed TPT of those that initiated in the previous reporting period. We then determined the proportion that initiated TPT in the previous reporting period and the proportion that completed TPT among all eligible PLHIV on ART (based on negative TB symptom screen), disaggregated by those newly initiating ART versus already receiving ART in the reporting period.
Nineteen of twenty-nine countries were retained for analysis. In the most recent reporting period (October 2018—March 2019), number of PLHIV eligible for TPT based on negative TB symptom screen ranged from 555—981,037 per country. Among eligible patients newly initiating ART, only 33% were initiated on TPT, and only 17% completed TPT. Among eligible patients already receiving ART, only 8% were initiated on TPT and only 6% completed a course. Since October 2017, overall TPT completion among all PLHIV that initiated in the previous reporting period increased from 59% to 69%. During the same time, among those already receiving ART, completion increased from 73% to 76%; completion was consistently lower (35–53%) in those newly initiating ART (Figure 1).
Programmatic data suggests TPT implementation remains low. Only one in six eligible patients who were newly initiated on ART completed a course of TPT in the most recent data. A marginal increase in completion rates was observed among those newly initiating ART; however, overall, completion rates remained consistently higher among those already receiving ART. Accelerated efforts will be necessary to provide TPT to all eligible PLHIV by reducing barriers to TPT initiation and completion among both new and existing patients.