Community-based referral for tuberculosis preventive therapy is effective for treatment completion

Area of Science:

• Public Health
• Infectious Diseases
• HIV/AIDS Research

Background:

• Tuberculosis preventive therapy (TPT) is crucial for reducing TB incidence and mortality in people with HIV (PWH).
• Implementation of TPT has faced challenges, necessitating innovative strategies for operationalization, particularly in high TB/HIV prevalence regions.

Purpose of the Study:

• To evaluate the effectiveness of a community-based identification and referral (CBR) strategy for delivering TPT to PWH in rural South Africa.
• To compare TPT adherence and treatment completion rates between a CBR group and a clinic-based comparison group.

Main Methods:

• A community-based TB/HIV intensive case finding strategy identified PWH eligible for TPT.
• Nurses and lay workers referred identified individuals to primary care clinics for a six-month isoniazid regimen.
• Adherence was measured via self-report and urine isoniazid metabolite testing; treatment completion was assessed over six months.
• Multivariable analysis identified predictors of TPT completion.

Main Results:

• The CBR group showed significantly higher treatment completion (90.0%) compared to the clinic-based group (79.2%).
• Adherence was significantly greater in the CBR group, confirmed by both self-report and urine testing.
• Independent predictors of completion included female gender and the CBR strategy.
• Participants in the CBR group had a higher median CD4 count at baseline.

Conclusions:

• Community-based identification and referral is an effective adjunctive strategy to improve TPT uptake and completion among PWH.
• This innovative approach can facilitate TPT implementation in TB-endemic regions, potentially reducing TB burden in PWH.
• The findings highlight the importance of community-based interventions in HIV care and TB prevention programs.