Completion rate of tuberculosis preventive therapy and incidence of tuberculosis among people living with the Human Immunodeficiency Virus on antiretroviral

<b>Introduction:</b> the World Health Organization (WHO) has recommended the use of tuberculosis preventive therapy (TPT) as part of a comprehensive care package for the reduction of tuberculosis (TB) incidence among people who are living with human immunodeficiency virus (PLWHA). When used optimally, TPT efficacy ranges between 60% and 90% among adults and children who are living with HIV. Despite the wide adoption of this intervention in South Africa, the country remains heavily burdened with high rates of TB/HIV co-infections, reported to be 59% in 2018. Reported challenges include low uptake and completion rates. This study aimed to determine the TPT completion rate and investigate the incidence of TB among antiretroviral therapy (ART) patients who were initiated on TPT. <b>Methods:</b> this descriptive cross-sectional retrospective cohort study was conducted among HIV-positive patients who were on ART, 18 years old and above, and had been initiated on TPT between June 2019 and June 2021 at the selected PHC facilities in Ekurhuleni East sub-District. We conducted record reviews and face-to-face interviews to collect data. These were captured onto a Microsoft Excel spreadsheet, cleaned, and coded before importation onto the Epiinfo version 7 statistical software package for statistical analyses. <b>Results:</b> the study found a majority of female participants, (60.5%). The median age of participants was 39.0 years (IQR=15), with most aged 50 years old and above, (21.3%). The treatment course of TPT was completed at the prescribed 12 months by 196 (30%) of the 395 participants. Only 12 (3%) of the participants were found to have TB, half 6 (50%) of which were breakthrough cases of TB. The reasons for non-completion of TPT included clinicians not offering it to patients, (46/276 (16.7%)). The barriers to TPT completion included not having a treatment supporter, (73.2%); p&lt;0.001, while disclosure of positive HIV status was found to facilitate TPT completion (83.2%); p&lt;0.001. <b>Conclusion:</b> the observed TPT completion rate of 30% needs to be addressed as it is far below the national threshold of 85%. The barriers and facilitators to TPT completion also require attention to help improve the TPT completion rate.

研究背景：世界卫生组织（World Health Organization, WHO）推荐将结核病预防性治疗（tuberculosis preventive therapy, TPT）作为综合护理包的组成部分，以降低人类免疫缺陷病毒感染者（people living with human immunodeficiency virus, PLWHA）的结核病（tuberculosis, TB）发病率。若规范使用，结核病预防性治疗在HIV感染者成人与儿童中的有效率可达60%~90%。尽管该干预措施在南非已得到广泛推广，但该国仍面临沉重的结核病/人类免疫缺陷病毒合并感染负担，2018年报道的合并感染率达59%。目前已报道的挑战包括服药依从率与治疗完成率偏低。本研究旨在明确接受结核病预防性治疗的抗逆转录病毒治疗（antiretroviral therapy, ART）患者的结核病预防性治疗完成率，并调查其结核病发病情况。

研究方法：本研究为描述性横断面回顾性队列研究，研究对象为2019年6月至2021年6月期间，在Ekurhuleni东部分区选定的初级卫生保健（Primary Health Care, PHC）机构接受抗逆转录病毒治疗、年龄≥18岁且启动了结核病预防性治疗的HIV阳性患者。研究通过病历回顾与面对面访谈的方式收集数据，将数据录入Microsoft Excel表格后进行清洗与编码，随后导入EpiInfo 7统计软件包开展统计学分析。

研究结果：研究纳入的受试者中女性占比达60.5%，为多数群体。受试者的年龄中位数为39.0岁（四分位距IQR=15），其中≥50岁者占21.3%。395名受试者中，共有196人（30.0%）按规定完成了为期12个月的结核病预防性治疗疗程。仅12名受试者（3.0%）确诊结核病，其中6例（50.0%）为治疗后突破感染病例。结核病预防性治疗未完成的原因包括：临床医师未向患者提供该治疗（46/276，16.7%）。影响结核病预防性治疗完成的障碍因素包括无治疗支持者（73.2%；p<0.001），而HIV阳性结果告知他人则可促进治疗完成（83.2%；p<0.001）。

研究结论：本研究观察到的结核病预防性治疗完成率仅为30%，远低于85%的国家阈值，亟需采取改进措施；同时，也需关注影响治疗完成的障碍与促进因素，以提升结核病预防性治疗的完成率。