Department of Public Health, Epidemiology and Biostatistics Unit, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa.
Health System Management and Policy Unit, Department of Public Health, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa.
Pan Afr Med J. 2024 Jul 4;48:86. doi: 10.11604/pamj.2024.48.86.43117. eCollection 2024.
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.
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.
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<0.001, while disclosure of positive HIV status was found to facilitate TPT completion (83.2%); p<0.001.
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.
世界卫生组织（WHO）建议将结核病预防治疗（TPT）作为降低艾滋病毒感染者（PLWHA）结核病发病率的综合护理方案的一部分。在最佳使用情况下，TPT 在成年人和儿童中的疗效在 60%至 90%之间。尽管南非广泛采用了这一干预措施，但该国仍然受到高结核/艾滋病毒合并感染率的沉重负担，据报道，2018 年这一比例为 59%。报告的挑战包括接受率和完成率低。本研究旨在确定 TPT 的完成率，并调查接受 TPT 治疗的抗逆转录病毒治疗（ART）患者中结核病的发病率。
本描述性、横断面、回顾性队列研究在东埃库鲁莱尼区选定的 PHC 设施中，对年龄在 18 岁及以上、2019 年 6 月至 2021 年 6 月期间开始接受 TPT 的艾滋病毒阳性患者进行了调查。我们进行了病历回顾和面对面访谈以收集数据。这些数据被捕获到 Microsoft Excel 电子表格中，在导入到 Epiinfo 版本 7 统计软件包进行统计分析之前进行了清理和编码。
研究发现大多数参与者为女性（60.5%）。参与者的中位年龄为 39.0 岁（IQR=15），其中大多数年龄在 50 岁及以上（21.3%）。在 395 名参与者中，有 196 名（30%）按规定在 12 个月内完成了 TPT 疗程。仅发现 12 名（3%）参与者患有结核病，其中一半（6 名，占 50%）为结核病突破病例。未完成 TPT 的原因包括临床医生未向患者提供（46/276（16.7%））。完成 TPT 的障碍包括没有治疗支持者（73.2%）；p<0.001，而公开艾滋病毒阳性状态被发现有助于完成 TPT（83.2%）；p<0.001。
观察到的 30%的 TPT 完成率需要解决，因为它远低于国家规定的 85%的门槛。TPT 完成的障碍和促进因素也需要引起关注，以帮助提高 TPT 的完成率。
