ArticleBMC public health2021
Assessment of the tuberculosis case-finding and prevention cascade among people living with HIV in Zambia - 2018: a cross-sectional cluster survey.
Article in BMC public health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Understanding Barriers to Uptake of TB Preventive Treatment Among People Living with HIV in Zimbabwe: A Qualitative Assessment of Healthcare Workers' Perspectives.Tropical medicine and infectious disease · 2026Article
- The implementation of tuberculosis preventive therapy in HIV care clinics in Africa, Asia and Latin America: a multiregional site survey.BMJ global health · 2026Article
- Awareness and acceptance of latent tuberculosis infection screening and preventive treatment among healthcare workers: a cross-sectional study in Chongqing, China.Frontiers in public health · 2026Article
- Analysis of Tuberculosis Preventive Treatment Cascade Among People With Human Immunodeficiency Virus in Georgia: A Mixed-Methods Study.Open forum infectious diseases · 2026Article
- A cluster-randomized trial of household vs incentive-based tuberculosis contact investigation in rural South Africa: implementation reach.PLOS global public health · 2025Article
- Knowledge and Attitudes About Screening and Preventive Treatment of Latent Tuberculosis Infection Among Patients with Rheumatic Diseases in Beijing, China.Infection and drug resistance · 2024Article
- Drop-offs in the isoniazid preventive therapy cascade among children living with HIV in western Kenya, 2015-2019.Journal of the International AIDS Society · 2022Article
- Addressing TB-related mortality in adults living with HIV: a review of the challenges and potential solutions.Therapeutic advances in infectious diseaseReview
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13 authors.
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Abstract
backgroundThe Ministry of Health Zambia recommends tuberculosis preventive treatment (TPT) with 6 months daily isoniazid for all people living with human immunodeficiency virus (HIV) after ruling out active tuberculosis disease. We sought to estimate the percentage of people living with HIV who progress through each stage of the tuberculosis case-finding and prevention cascade in two provinces with the highest tuberculosis burden in Zambia.
methodsIn this cross-sectional survey, we used a two-stage cluster sampling method. We sampled 12 healthcare facilities with probability proportional to size. Patient volume determined facility cluster size. During October 2018, from each facility we systematically sampled medical records of adults and children living with HIV. Our primary outcome of interest was TPT initiation rate among eligible people living with HIV, weighted for complex survey design. The Rao-Scott adjusted chi-square test was used to test for differences in TPT initiation rate and other indicators from the tuberculosis prevention cascade by age group and province of residence. Additionally, we conducted semi-structured interviews with healthcare workers at each facility to assess TPT knowledge and identify challenges to its implementation.
resultsWe sampled 482 records of people living with HIV (including 128 children living with HIV). Excluding two people diagnosed with tuberculosis disease before enrollment in HIV care, 93.4% underwent tuberculosis symptom screening. Of those, 4.7% were diagnosed with tuberculosis disease and 95.3% were TPT-eligible, of whom 24.7% initiated TPT. TPT initiation was lower among eligible children (7.7%) compared with adults (25.2%, p = 0.03) and Copperbelt residents (3.1%) compared with Lusaka residents (35.8%, p < 0.01). TPT completion rate was 38.4% among people living with HIV who initiated the 6-month course. Among interviewed healthcare workers, 58.3% (unweighted) incorrectly relayed the number of symptoms needed for a positive tuberculosis symptom screen, 83.3% (unweighted) reported insufficient isoniazid stockpile for completion at the time of TPT initiation, and only 27.3% (unweighted) reported receiving TPT-specific training.
conclusionsTPT uptake among people living with HIV in Zambia is challenged by inconsistent tuberculosis screening, lack of TPT training for healthcare workers, and supply chain inefficiencies. Addressing these barriers may increase TPT initiations and improve outcomes among people living with HIV.
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