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Barriers to TB preventive treatment remain in Uganda, despite improvements

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New research shows barriers to accessing tuberculosis (TB) preventive treatment remain in Uganda, even though coverage is high amongst many people living with HIV.

The ‘Evaluation of Adherence, Completion, Events for Tuberculosis Preventive Treatment (ACE TPT)’ study is exploring how TB preventive treatment (TPT) can be improved for people living with HIV, including children.

Initial findings indicate that the main reason for 91% of eligible people not starting TPT was missed appointments and opportunities – 81% of people living with HIV already on antiretroviral therapy (ART) and 96% of people living with HIV new on ART (i.e. for less than one month), respectively.

The research team, led by The Union, identified the barriers to access, which include:

  • 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

The findings are based on data analysis and health facility monitoring from June to December 2022.

The study established that 90% of people living with HIV who were already on ART had been initiated on TPT by December 2022. Of those, 69% had completed treatment and 31% were still on TPT.

However, only 11% of people living with HIV new on ART were on TPT in June 2022. This increased to 50% by December 2022.

The study enrolled 306 people living with HIV new 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, said: “Despite improvements, barriers still hamper TPT implementation. Continuous patient education would help address stigma and apprehension about TPT.

“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.”

The research project began in May 2022, with the training of healthcare workers on the management of TB infection, including recording and reporting of TB screening and TPT provision. In June 2022, the people living with HIV were enrolled to help evaluate the TPT provision. Followed up with the enrolled participants and data collection was then undertaken in December 2022.

John Paul concluded: “These results and lessons learned will help us to identify approaches to improve and strengthen the initiation, adherence and completion of the TB preventive treatment for all people and children living with HIV in Uganda.”

The research project will continue in September 2024, once the project team has conducted further monitoring, data analysis and training.

The Union is delivering the study in collaboration with U.S. Centers for Disease Control and Prevention, and with support from the National TB Program and the AIDS Control Program, Ministry of Health Uganda.



Notes to editor

About The Union

Established in 1920, the International Union Against Tuberculosis and Lung Disease (The Union) is committed to creating a healthier world for all, free of tuberculosis and lung disease.
The Union is the world’s first global health organisation and a global leader in ending TB. Its members, staff, and consultants work in more than 140 countries.
The Union strives to end suffering due to tuberculosis and lung diseases, old and new, by advancing better prevention and care. It seeks to achieve this by the generation, dissemination, and implementation of knowledge into policy and practice.
The Union aims to ensure that no one is left behind, people are treated equally and we have a focus on vulnerable and marginalised populations and communities.

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