The AIDS Support Organization, Kampala, Uganda.
MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
PLoS One. 2024 Jan 2;19(1):e0296239. doi: 10.1371/journal.pone.0296239. eCollection 2024.
BACKGROUND: Tuberculosis (TB) remains the leading cause of death among people living with HIV (PLHIV). To prevent TB among PLHIV, the Ugandan national guidelines recommend Isoniazid Preventive Therapy (IPT) across differentiated service delivery (DSD) models, an effective way of delivering ART. DSD models include Community Drug Distribution Point (CDDP), Community Client-led ART Delivery (CCLAD), Facility-Based Individual Management (FBIM), Facility-Based Group (FBG), and Fast Track Drug Refill (FTDR). Little is known about the impact of delivering IPT through DSD. METHODS: We reviewed medical records of PLHIV who initiated IPT between June-September 2019 at TASO Soroti (TS), Katakwi Hospital (KH) and Soroti Regional Referral Hospital (SRRH). We defined IPT completion as completing a course of isoniazid within 6-9 months. We utilized a modified Poisson regression to compare IPT completion across DSD models and determine factors associated with IPT completion in each DSD model. RESULTS: Data from 2968 PLHIV were reviewed (SRRH: 50.2%, TS: 25.8%, KH: 24.0%); females: 60.7%; first-line ART: 91.7%; and Integrase Strand Transfer Inhibitor (INSTI)-based regimen: 61.9%. At IPT initiation, the median age and duration on ART were 41.5 (interquartile range [IQR]; 32.3-50.2) and 6.0 (IQR: 3.7-8.6) years, respectively. IPT completion overall was 92.8% (95%CI: 91.8-93.7%); highest in CDDP (98.1%, 95%CI: 95.0-99.3%) and lowest in FBG (85.8%, 95%CI: 79.0-90.7%). Compared to FBIM, IPT completion was significantly higher in CDDP (adjusted rate ratio [aRR] = 1.15, 95%CI: 1.09-1.22) and CCLAD (aRR = 1.09, 95% CI 1.02-1.16). In facility-based models, IPT completion differed between sites (p<0.001). IPT completion increased with age for FBIM and CCLAD and was lower among female participants in the CCLAD (aRR = 0.82, 95%CI 0.67-0.97). CONCLUSION: IPT completion was high overall but highest in community-based models. Our findings provide evidence that supports integration of IPT within DSD models for ART delivery in Uganda and similar settings.
背景：结核病（TB）仍然是艾滋病毒感染者（PLHIV）死亡的主要原因。为了预防 PLHIV 中的结核病，乌干达国家指南建议在差异化服务提供（DSD）模式下使用异烟肼预防治疗（IPT），这是提供 ART 的有效方法。DSD 模式包括社区药物分发点（CDDP）、社区客户主导的 ART 交付（CCLAD）、基于机构的个体管理（FBIM）、基于机构的群体（FBG）和快速药物补充（FTDR）。对于通过 DSD 提供 IPT 的影响知之甚少。
方法：我们回顾了 2019 年 6 月至 9 月期间在 TASO 索罗蒂（TS）、卡塔基维医院（KH）和索罗蒂地区转诊医院（SRRH）开始接受 IPT 的 PLHIV 的医疗记录。我们将 IPT 完成定义为在 6-9 个月内完成异烟肼疗程。我们利用修正泊松回归来比较 DSD 模型之间的 IPT 完成情况，并确定每个 DSD 模型中与 IPT 完成相关的因素。
结果：共审查了 2968 名 PLHIV 的数据（SRRH：50.2%，TS：25.8%，KH：24.0%）；女性：60.7%；一线 ART：91.7%；和整合酶链转移抑制剂（INSTI）为基础的方案：61.9%。在 IPT 开始时，中位年龄和 ART 持续时间分别为 41.5（四分位间距[IQR]；32.3-50.2）和 6.0（IQR：3.7-8.6）年。IPT 总体完成率为 92.8%（95%CI：91.8-93.7%）；CDDP 最高（98.1%，95%CI：95.0-99.3%），FBG 最低（85.8%，95%CI：79.0-90.7%）。与 FBIM 相比，CDDP 和 CCLAD 的 IPT 完成率显著更高（调整后的比率比[aRR]分别为 1.15，95%CI：1.09-1.22 和 1.09，95%CI 1.02-1.16）。在基于机构的模型中，站点之间的 IPT 完成情况存在差异（p<0.001）。IPT 完成率随年龄的增加而在 FBIM 和 CCLAD 中增加，而在 CCLAD 中女性参与者的 IPT 完成率较低（aRR = 0.82，95%CI 0.67-0.97）。
结论：IPT 总体完成率较高，但在社区模式中最高。我们的研究结果提供了证据，支持在乌干达和类似环境中在 DSD 模式下整合 IPT 以提供 ART 服务。
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