A recent study conducted by The Union has revealed that barriers persist in accessing tuberculosis (TB) preventive treatment in Uganda, even though many people living with HIV have high coverage.
The ‘Evaluation of Adherence, Completion, Events for Tuberculosis Preventive Treatment (ACE TPT)’ study aims to identify ways to improve TB preventive treatment for people living with HIV, including children.
Initial findings from the study indicate that the primary reason for 91% of eligible individuals not starting TB preventive treatment was missed appointments and opportunities.
Specifically, 81% of people living with HIV who were already on antiretroviral therapy (ART) and 96% of those newly on ART (i.e., for less than one month) missed the opportunity to start TB preventive treatment.
The research team, led by The Union, identified several barriers to access TB preventive treatment, including:
- Lengthy TPT initiation procedures
- Lack of staff time to screen patients for eligibility
- Concerns about adverse events
- Alcoholism
- Stigma
- Hesitancy among otherwise-healthy people living with HIV
Data analysis and health facility monitoring from June to December 2022 formed the basis of the findings. By December 2022, 90% of people living with HIV who were already on ART had initiated TB preventive treatment, with 69% completing the treatment and 31% still on it. However, in June 2022, only 11% of people living with HIV who were new to ART were on TB preventive treatment, a number that increased to 50% by December 2022.
The study enrolled 306 people living with HIV newly on ART and 392 people living with HIV already on ART, aged 15 and over, across 12 health facilities.
John Paul Dongo, Director of The Union Uganda Office, expressed that despite some improvements, barriers continue to hinder the implementation of TB preventive treatment. Continuous patient education is essential to address stigma and apprehension surrounding TB preventive treatment.
“An efficient medicine supply chain, wider roll-out of shorter regimens, streamlined patient flow, implementation of adherence monitoring and timely follow-up of patients are important to improve TPT completion,” he said.
Additionally, an efficient medicine supply chain, wider rollout of shorter regimens, streamlined patient flow, adherence monitoring, and timely follow-up of patients are crucial to improving TB preventive treatment completion.
The research project commenced in May 2022, with healthcare workers trained on managing TB infection, including recording and reporting TB screening and TPT provision.
In June 2022, people living with HIV were enrolled to evaluate TPT provision. Data collection was undertaken in December 2022, and the research project will continue in September 2024 after further monitoring, data analysis, and training by the project team.
The insights gained from this study will help identify approaches to enhance and strengthen the initiation, adherence, and completion of TB preventive treatment for all people and children living with HIV in Uganda.
ends