Increased uptake of tuberculosis preventive therapy (TPT) among people living with HIV following the 100-days accelerated campaign: A retrospective review of routinely collected data at six urban public health facilities in Uganda.
Increased uptake of tuberculosis preventive therapy (TPT) among people living with HIV following the 100-days accelerated campaign: A retrospective review of routinely collected data at six urban public health facilities in Uganda.
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DOI：
10.1371/journal.pone.0268935
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
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结核病预防性治疗（TPT）能有效降低艾滋病病毒感染者（PLHIV）中高危人群患活动性结核病的几率。乌干达卫生部于2019年7月发起了一项为期100天的活动，以在艾滋病病毒感染者中扩大结核病预防性治疗的规模。我们试图研究该活动对结核病预防性治疗接受情况的趋势以及艾滋病病毒治疗患者中与结核病预防性治疗接受和完成相关的特征的影响。我们回顾了2016年至2019年乌干达六个城市公共卫生机构常规收集的数据。对乌干达坎帕拉六个公共卫生机构的艾滋病病毒治疗数据库和纸质结核病预防性治疗登记册进行了回顾性审查。使用具有稳健标准误的泊松回归模型以及广义估计方程（GEE）模型，对15岁及以上艾滋病病毒感染者在这4年中结核病预防性治疗（以异烟肼单一疗法形式提供）的接受和完成情况的估计趋势以及相关因素进行了研究。平均而言，在这六个卫生机构中，每个日历年共有39774名15岁及以上的艾滋病病毒感染者有资格接受结核病预防性治疗。在这4年中，超过70%为女性（范围：73.5% - 74.6%），中位年龄在33至34岁之间。从2016年第一季度到2019年第二季度，结核病预防性治疗的接受率一直低于25%，但是，正如预期的那样，在2019年第二季度（即100天加速结核病预防性治疗干预措施推出之前）和第三季度（即100天加速结核病预防性治疗干预措施推出之后），接受率分别从22.1%显著提高到61.2%，约提高了3倍。即使在对患者的基线特征进行调整后，这种增长仍然非常显著（调整后的患病率比[aPR] = 2.58 [95%置信区间2.45, 2.72]，P值<0.001）。结核病预防性治疗的完成率在大多数时间一直较高，在70%以上，但是，在2018年第四季度以及100天加速结核病预防性治疗干预措施推出后的接下来两个季度中开始接受治疗的患者中，完成率显著提高（即2018年第四季度、2019年第一季度和第二季度开始接受治疗的个体中，结核病预防性治疗完成率分别为83.2%、95.3%和97.1%）。即使在对患者的基线特征进行调整后，在此期间结核病预防性治疗完成率的提高仍然显著（对于2019年第一季度和第二季度开始接受治疗的个体，与2018年第四季度开始接受治疗的个体相比，aPR[95%置信区间]分别为1.09[1.04, 1.14]，P值<0.001，以及1.10[1.05, 1.15]，P值<0.001）。与有抗逆转录病毒治疗经验的患者相比，未接受抗逆转录病毒治疗或新开始抗逆转录病毒治疗的患者，以及在开始结核病预防性治疗时怀孕的患者与结核病预防性治疗完成情况不佳相关，而年龄较大（≥25岁与15 - 24岁相比）与较高的结核病预防性治疗完成率相关。这项有针对性的100天活动显著提高了艾滋病病毒感染者中结核病预防性治疗的接受率和完成率，这表明这是一种可行的追赶策略，符合世界卫生组织的指南。需要对100天结核病预防性治疗干预措施之后的更多年份的数据进行进一步分析，以评估所观察到的成果的可持续性。
Tuberculosis preventive therapy (TPT) effectively decreases rates of developing active tuberculosis disease in people living with HIV (PLHIV) who are at increased risk. The Uganda Ministry of Health launched a 100-day campaign to scale-up TPT in PLHIV in July 2019. We sought to examine the effect of the campaign on trends of TPT uptake and characteristics associated with TPT uptake and completion among persons in HIV care. We retrospectively reviewed routinely collected data from 2016 to 2019 at six urban public health facilities in Uganda. HIV care database and paper-based TPT registers at six public health facilities in Kampala, Uganda were retrospectively reviewed. Estimated trends of TPT (given as Isoniazid monotherapy) uptake and completion across the 4 years, among PLHIV aged 15 years and above, and factors associated, were examined using Poisson regression model with robust standard errors using generalized estimating equation (GEE) models. On average, a total of 39,774 PLHIV aged 15 years and above were eligible for TPT each calendar year at the six health facilities. Across all 4 years, more than 70% were females (range: 73.5% -74.6%) and the median age ranged from 33 to 34 years. From 2016 quarter one to 2019 quarter two, TPT uptake was consistently below 25%, but, as expected, the uptake significantly increased by about 3-folds from 22.1% to 61.2%, in 2019 quarter two (i.e. before the roll-out of the 100-day accelerated TPT intervention) and quarter three (i.e. after the roll-out of the 100-day accelerated TPT intervention) respectively. This increase remained highly significant even after adjusting for patients’ baseline characteristics (adjusted prevalence ratio [aPR] = 2.58 [95%CI 2.45, 2.72], P-value<0.001). TPT completion was consistently high at above 70% at most of the time, but, it increased significantly among those initiated during 2018 quarter four and in the subsequent two quarters after the roll-out of the 100-day accelerated TPT intervention (i.e. TPT completion was: 83.2%, 95.3%, and 97.1% among individuals initiated during 2018 quarter4, and 2019 quarters 1 and 2, respectively). The increase in TPT completion during this period remained significant even after adjusting for patients’ baseline characteristics (aPR [95%CI] = 1.09 [1.04, 1.14], P value<0.001, and 1.10 [1.05,1.15], P value<0.001, for individuals initiated during 2019 quarter 1, and 2, respectively compared to those initiated during 2018 quarter 4). Not on ART or newly started on ART compared to ART experienced, and pregnant at TPT initiation compared to not pregnant were associated with poor TPT completion, whereas older age (≥25 years versus 15–24 years) was associated with higher TPT completion. The targeted 100-day campaign dramatically increased TPT uptake and completion among PLHIV suggesting a viable catch up strategy to meet WHO guidelines. Future analysis with additional years of data post 100-days TPT intervention is required to evaluate the sustainability of the observed gains.
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DOI：
10.5588/ijtld.17.0758
发表时间：
2018-06-01
期刊：
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
影响因子：
--
作者：
Pathmanathan I;Ahmedov S;Pevzner E;Anyalechi G;Modi S;Kirking H;Cavanaugh JS
通讯作者：
Cavanaugh JS
影响因子：
4.4
作者：
Tsai, Alexander C.;Bangsberg, David R.;Bwana, Mwebesa;Haberer, Jessica E.;Frongillo, Edward A.;Muzoora, Conrad;Kumbakumba, Elias;Hunt, Peter W.;Martin, Jeffrey N.;Weiser, Sheri D.
通讯作者：
Weiser, Sheri D.
DOI：
10.1080/09540121.2017.1283390
发表时间：
2017-01-01
影响因子：
1.7
作者：
Jacobson, Karen B.;Niccolai, Linda;Shenoi, Sheela V.
通讯作者：
Shenoi, Sheela V.
影响因子：
158.5
作者：
Danel, Christine;Moh, Raoul;Anglaret, Xavier
通讯作者：
Anglaret, Xavier
影响因子：
3.7
作者：
Robert, Masanja;Todd, Jim;Maokola, Werner
通讯作者：
Maokola, Werner