Loss to follow-up among people living with HIV on tuberculosis preventive treatment at four regional referral hospitals, Uganda, 2019–2021

Abstract

Introduction

Tuberculosis (TB) remains the leading cause of death among people living with HIV (PLHIV). TB preventive treatment (TPT) can prevent active TB infection in PLHIV for several years after it is completed. During 2019–2021, the six-month course of TPT (using isoniazid) was the most readily available in Uganda; however, program data indicated a TPT program loss to follow-up (LTFU) rate of 12 % during this period. We evaluated factors associated with TPT LTFU among PLHIV in four regional referral hospitals (RRHs) in Uganda from 2019 to 2021.

Methods

We abstracted program data from TPT registers on patient LTFU at Masaka, Mbale, Mubende, and Jinja RRHs. Additional data collected included client demographics, duration on HIV antiretroviral therapy (ART), year of TPT initiation, adherence, and point of entry. LTFU was defined as the failure to finish six consecutive months of isoniazid without stopping for more than two months at a time. We conducted bivariate analysis using the chi-square test for independence. Variables with p < 0.05 in bivariate analysis were included in a logistic regression model to establish independent factors associated with LTFU.

Results

Overall, 24,206 clients were started on TPT in the four RRHs. Their median age was 40 years (range, 1–90 years), and 15,962 (66 %) were female. A total of 22,260 (92 %) had TPT adherence >95 %. Independent factors associated with LTFU included being on ART for <3 months (AOR: 3.1, 95 % CI: 2.1–4.5) and 20–24 years (AOR: 4.7, 95 % CI: 1.9–12) or 25–29 years (AOR: 3.3, 95 % CI: 1.3–8.2) compared to 15–19 years.

Conclusions

PLHIV just starting ART and young adults had higher odds of being LTFU from TPT during 2019–2021 in the four RRHs. Close follow-up of PLHIV aged 20–29 years and those newly initiated on ART could improve TPT completion.