Analysis of Tuberculosis Preventive Treatment Cascade Among People With Human Immunodeficiency Virus in Georgia: A Mixed-Methods Study.

Background: Tuberculosis preventive treatment (TPT) is crucial for reducing tuberculosis (TB) incidence and related mortality among people with human immunodeficiency virus (HIV); however, its implementation in Georgia faces challenges. In this study, we aimed to explore the TPT care cascade among people with HIV (PWH) in Georgia. Methods: Using a mixed-methods approach, we assessed TPT uptake, adherence, and impact on TB development within the 2019-2020 cohort of newly diagnosed PWH across 4 major HIV service providers in Georgia. With qualitative analysis under the Consolidated Framework for Implementation Research, we identified barriers and facilitators to its implementation. Results: Among 1165 PWH, only 11.8% initiated TPT with isoniazid. Thirty-two developed active TB (incidence rate, 10/1000 person-years [95% confidence interval, 9.6-10.4]), none of whom received TPT. Only 43% of 137 PWH on TPT adhered for 3-6 months; 29 (21.1%) completed the full course. The study revealed poor TPT service coordination, worsened by major data limitations. Interviews identified several barriers to effective TPT implementation, summarized into 3 broad categories: the need for TPT service integration into HIV care, the potential development of an integrated electronic data system, and training gaps. Conclusions: Our study revealed low TPT coverage among Georgian PWH and significant data gaps. Findings underscore the need to reevaluate the TPT care cascade, emphasizing improved record-keeping and reporting practices through an integrated electronic system. Enhancing access by integrating TPT into HIV care, reducing stigma through streamlined referrals, and strengthening healthcare worker training are critical to increasing TPT uptake and ultimately reducing TB morbidity and mortality among PWH in Georgia.