Skip to main content
NCBI home page
BMJ Global Health logoLink to BMJ Global Health
. 2026 Jan 27;11(1):e018469. doi: 10.1136/bmjgh-2024-018469

The implementation of tuberculosis preventive therapy in HIV care clinics in Africa, Asia and Latin America: a multiregional site survey

Remo Schmutz 1,2,3,0, Nicolas Banholzer 1,4,0, Kate Shearer 5, Jonathan E Golub 5, Claudia P Cortes 6, Eugène Messou 7, Nana Mbonze 8, Joseph Musaazi 9, Guy Muula 10, Anggraini Alam 11, Diana Varela 12, Armel Poda 13, Ellen Brazier 14, Lameck Diero 15, Cordelia Kunzekwenyika 16, Awachana Jiamsakul 17, Vanessa Rouzier 18,19, Marcel Zannou 20, Marcel Yotebieng 21, Leslie A Enane 22, Dickman Gareta 1,23, Jorge Pinto 24, Eric Komena 25, Patricia Lelo 26, Winnie Muyindike 27, Jonathan Euvrard 28, Stephany N Duda 29, N Sarita Shah 30, Samyra R Cox 31, Marie Ballif 1,32,1, Lukas Fenner 1,✉,1; The IeDEA global consortium
PMCID: PMC12853508  PMID: 41592909

Abstract

Summary

Introduction

Towards the ‘End TB Strategy’ targets, the WHO recommends the provision of tuberculosis (TB) preventive therapy (TPT) for high-risk groups including people living with HIV (PLWH). 3 years after the release of the updated 2020 WHO guidelines, we investigated the implementation of TPT services at HIV clinics in low-income and middle-income countries (LMICs), focusing on TB screening, populations eligible for TPT and available TPT regimens.

Methods

In 2023, we surveyed HIV care clinics in the International Epidemiology Databases to Evaluate AIDS consortium in Africa, the Asia-Pacific and Latin America and the Caribbean. We used descriptive statistics to summarise TPT implementation according to WHO guidelines and multivariable logistic regression models to estimate associations with clinic characteristics.

Results

Of 172 HIV clinics included, 142 (83%) were in Africa, 22 (13%) in the Asia-Pacific and 8 (5%) in Latin America; 108 (63%) were located in urban areas. After ruling out active TB, TPT was reportedly offered to PLWH (122 clinics, 71%), household contacts of individuals with active TB (120 clinics, 70%) and other high-risk populations. TPT for PLWH was more frequently available in clinics in lower-income and low-middle-income countries, in high TB burden countries, and in district hospitals compared with other facility types. Clinics reported use of isoniazid-based (160 clinics, 93%) and shorter rifamycin-based (129 clinics, 75%) TPT regimens. Reported barriers to TPT initiation included patient refusal at 71 (41%) and drug shortages at 67 (39%) clinics.

Conclusions

TPT was available at most HIV care clinics in LMICs but further efforts are needed to reinforce WHO recommendations and ensure that TPT is consistently accessible to people at higher risk of developing active TB, especially PLWH.

Keywords: Tuberculosis, HIV, Prevention strategies, Cross-sectional survey

WHAT IS ALREADY KNOWN ON THIS TOPIC.

WHAT THIS STUDY ADDS

  • TPT was available at HIV care clinics in low-income and middle-income countries, but only partly offered to people at the highest risk of developing TB, especially PLWH.

  • TPT for PLWH was associated with country income level, TB burden, region and clinic size.

  • The most commonly reported barriers to TPT initiation were patient refusal and drug shortages.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

  • This study identified gaps in the implementation of TPT that need to be addressed to ensure the success of the End TB Strategy.

  • We showed the importance of supporting and monitoring TPT implementation to ensure that people who would benefit most from TPT can readily access it, in particular PLWH.

  • Greater efforts should be made to reduce barriers to TPT and to scale up shorter regimens.

Introduction

It is estimated that about one-quarter of the world’s population is prevalently infected with Mycobacterium tuberculosis.1 2 People with immune weaknesses and people living with HIV (PLWH) are at higher risk of developing active tuberculosis (TB), and TB is one of the leading causes of death among PLWH.3 4 Globally, 6.1% of incident TB was recorded among PLWH in 2023, with large regional disparities, exceeding 50% of TB among PLWH in parts of Southern Africa.5 Furthermore, the global mortality attributable to TB almost doubled the one attributable to HIV.5

Since 2004, the WHO has recommended TB preventive therapy (TPT) for PLWH and for other individuals at increased risk of developing TB. TPT is a prophylaxis that can be taken orally to prevent TB infection. TPT reduces TB incidence, especially in low-income and middle-income countries (LMICs) with high prevalence of HIV-associated TB, thereby contributing to the WHO’s ‘End TB Strategy’.6,8 Yet, in 2023, the TPT coverage was estimated to have reached 21% among household contacts of people diagnosed with TB, and 56% among PLWH, both below the 90% global target to be reached by 2027.5

TPT is particularly important for PLWH because of their higher risk of developing TB.3 4 Clinical efficacy and cost-effectiveness of TPT have been shown using 6-month isoniazid-based TPT or shorter rifamycin-containing regimens.9,14 Shorter TPT regimens have the advantage of being less toxic than longer isoniazid monotherapy, reducing adverse events and treatment discontinuation.11 15 Clinic-level provision of TPT may be limited by gaps in screening practices to exclude active TB, drug shortages and insufficient resources, which can contribute to challenges in TPT uptake and completion, as well as substantial losses along the TPT care cascade.16 17 To improve accessibility and retention in care, especially since the COVID-19 pandemic, HIV services, including the provision of TPT, have increasingly moved to client-centred care, for instance, through differentiated service delivery, which allows care to be delivered in and through communities rather than clinics.18 19

In 2020, the WHO updated their guidelines on TB prevention, which specifically recommended shorter TPT regimens and identified three major eligibility groups for TPT15: (1) PLWH, irrespective of their age and degree of immunosuppression, even if testing for TB infection is unavailable; (2) household contacts exposed to a person with pulmonary TB, regardless of their HIV status and (3) other people at risk, including healthcare workers and people in prisons, people on immunosuppressive therapy or dialysis. Little is known about the global implementation of TPT, especially in LMICs where the burden of TB and HIV is high. In this study, we used data from a site-level survey to evaluate the implementation of TPT in a global sample of HIV care clinics in LMICs from the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium in Africa, the Asia-Pacific and Latin America and the Caribbean, with a focus on TB screening and testing, eligible populations and TPT regimens available.

Methods

Study setting

The IeDEA (www.iedea.org) was established in 2006 and comprises close to 400 HIV care and treatment sites in 44 countries that contribute longitudinal data for more than 2 million individuals living with and at risk for HIV, including adults and children.20 IeDEA conducts periodic surveys every 2–3 years at participating clinics to collect data on site characteristics and topics related to HIV. This study was conducted at HIV care clinics in LMICs from the IeDEA consortium in Africa, the Asia-Pacific and Latin America and the Caribbean.21

Data collection and definitions

The survey was conducted between 3 August and 31 December 2023. Each participating clinic submitted one survey. Respondents were knowledgeable about the clinic capacity and the services offered within the HIV clinic and were encouraged to consult colleagues at their site if necessary. In addition to clinic characteristics, we collected data on TPT availability, eligibility and regimens as well as barriers to TPT implementation. The survey was provided in English and French as an online questionnaire or on paper. All survey data were collected and managed using Research Electronic Data Capture (REDCap), a secure, web-based software.22 23 Questions were asked with prefixed answer options, and in the case of ‘others’, there was also an option for free text. The income level for each country is classified according to the World Bank Country and Lending Groups classifications for the 2024 fiscal year into low-income, lower-middle-income and upper-middle-income economies.24 We obtained country-level HIV prevalence data—the estimated percentage of adults aged 15–49 PLWH—from the UNAIDS website in 2023.25 We classified countries as having low (<1%), medium (1%–5%) and high HIV prevalence (>5%). We classified TB burden according to the WHO list of High Burden Countries (HBC) for TB, HIV-associated TB and drug-resistant TB.26 We defined high-TB-burden countries as those included in any of these lists. We defined the degree of TB and HIV service integration as ‘full integration’ (TB diagnostics and treatment available at the same facility as HIV care services), ‘partial integration’ (either TB diagnostics or treatment available) or ‘not integrated’ (TB diagnostics and treatment not available at the participating HIV care clinic).27

Statistical analyses

We assessed the implementation of TB screening and testing services, provision of TPT to eligible populations according to the 2020 WHO recommendations,15 barriers for TPT implementation, and availability of different TPT regimens. Survey results were summarised across subgroups (PLWHIV, household contacts and other risk groups) by the number and proportion of clinics. In an exploratory analysis to highlight patterns across our diverse sample of HIV clinics, we used multivariable logistic regression models to estimate the association of TPT implementation for priority groups as defined by the WHO (PLWH, household contacts of people diagnosed with TB, other persons at high risk of TB) and use of short-course TPT regimens (defined as rifamycin-based regimens of less than 6 months) with clinic characteristics. We started with the full model, which included all variables, and then removed any covariates that were collinear, as indicated by a variance inflation factor greater than four. The only exclusion was national HIV prevalence. Associations were reported as odds ratios (ORs) with 95% confidence intervals (95% CIs), derived from univariable and multivariable models. All analyses were performed in R V.4.4.0.28

Patient and public involvement

We discussed the objectives, the content and the study design with the relevant working groups within the global IeDEA consortium (including the Site Assessment and the Tuberculosis and Lung Health working groups). The site survey was pilot-tested at selected representative sites to optimise the data collection procedures. Patients were not involved in the design, recruitment or conduct of this survey study. We will disseminate the results of this study to the participating HIV clinics and our broader research networks.

Role of the funding source

The funder of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report.

Results

Participating HIV care clinics

The survey was distributed to 180 HIV care clinics in LMICs, and 178 completed the questionnaire (99%); 6 (3%) facilities reported that TPT was not available at their site and were therefore excluded from subsequent analysis (online supplemental table 1). Of the remaining 172 clinics providing TPT, 16 (9%) were in West Africa, 24 (14%) in Central Africa, 71 (41%) in East Africa, 31 (18%) in Southern Africa, 22 (13%) in the Asia-Pacific and 8 (5%) in Latin America and the Caribbean. Most clinics were in urban settings (108, 63%), and fully integrated TB care as part of HIV services was available at 107 clinics (62%) (online supplemental table 2). The provision of any TPT training to healthcare workers varied from 50% to 100% depending on the region (online supplemental table 3). In providing TPT, almost all clinics (171/172) reported using symptom screening to identify patients with active TB who require a full TB treatment regimen (online supplemental table 3). Only 29 sites (17%) reported having TB infection testing available to assess the eligibility of PLWH for TPT.

Implementation of TPT according to WHO recommendations

Eligible populations, associated factors and barriers to TPT uptake

Most HIV care clinics reported providing TPT to PLWH (mean across subgroups: 122, 71%; range 60%–78%), and to household contacts of people with active TB (mean across subgroups: 120, 70%; range 63%–80%). TPT was less often provided to other populations at risk (mean across subgroups: 48, 27%; range 16%–52%) who were also eligible for TPT regardless of their HIV status, including healthcare workers at 90 (52%) clinics, prisoners at 81 (47%) and immigrants from high TB burden countries at 62 (36%) clinics (figures1 2). The proportions stratified by region, TB burden, national HIV prevalence and by the level of HIV/TB service integration are shown in online supplemental figure 1. Provision of TPT for the three priority groups was associated with clinic and contextual characteristics, including country income level, TB burden and level of care provision (table 1, online supplemental table 4). TPT provision to PLWH was greater in low-income countries (OR: 2.43, 95% CI 1.18 to 5.00) and low-middle-income countries (2.94, 95% CI 1.59 to 5.45) compared with upper-middle-income countries, in countries with a high TB burden (1.87, 95% CI 1.10 to 3.19) compared with low TB burden countries, and was lower in health centres (0.32, 95% CI 0.10 to 1.00) and regional, provincial or university hospitals (0.24, 95% CI 0.07 to 0.80) compared to district hospitals. TPT provision to household contacts of people diagnosed with TB regardless of their HIV status was higher in district hospitals. TPT provision to other people at increased risk of TB regardless of their HIV status was greater in low-income/low-middle-income countries, in countries with high TB burden, in clinics with TPT training and in district hospitals. The complete association analysis with the corresponding reference groups is shown in table 1. The results from multivariable (table 1) and univariable (online supplemental table 4) analysis showed broadly similar associations between TPT implementation and clinic characteristics.

Figure 1. Maps showing the countries represented by the 172 participating HIV care clinics and the populations eligible for tuberculosis preventive therapy (TPT), according to the priority groups defined in the WHO’s recommendations.15 (a) Proportion (region-specific) of clinics offering TPT to any of the subgroups of people living with HIV; (b) Proportion of clinics offering TPT to any of the subgroups of household contacts of people with active tuberculosis; (c) Proportion of clinics offering TPT to any of the subgroups of other people at risk. See figure 2 for TPT proportions per subgroups within PLWHIV, household contacts and other subgroups.

Figure 1

Open in a new tab
Figure 2. Proportion of HIV care clinics offering tuberculosis preventive therapy for the priority groups defined in the WHO’s recommendations.15 TB, tuberculosis; MDR, multidrug resistant.

Figure 2

Open in a new tab
Table 1. Associations between the implementation of TPT for each of the three target groups defined by the WHO recommendations15 and site characteristics at 172 HIV care clinics.
Variable People living with HIV Household contacts Other people at risk
OR 95% CI P value OR 95% CI P value OR 95% CI P value
Level of integration 0.116 0.294 0.175
 No 1.00 Reference 1.00 Reference 1.00 Reference
 Full 0.30 0.08 to 1.21 2.01 0.86 to 4.70 1.80 0.92 to 3.53
 Partial 0.32 0.08 to 1.31 2.01 0.82 to 4.91 1.70 0.85 to 3.37
Income level 0.003 0.792 <0.001
 Upper middle 1.00 Reference 1.00 Reference 1.00 Reference
 Low 2.43 1.18 to 5.00 0.74 0.33 to 1.65 1.72 1.08 to 2.74
 Low middle 2.94 1.59 to 5.45 0.82 0.41 to 1.64 3.24 2.12 to 4.93
TB high burden country 0.024 0.337 <0.001
 No 1.00 Reference 1.00 Reference 1.00 Reference
 Yes 1.87 1.10 to 3.19 1.33 0.78 to 2.27 2.40 1.70 to 3.39
TPT training 0.512 0.824 0.004
 No 1.00 Reference 1.00 Reference 1.00 Reference
 Yes 1.36 0.68 to 2.70 0.86 0.37 to 2.00 1.73 1.18 to 2.55
Facility level of care 0.024 <0.001 <0.001
 District hospital 1.00 Reference 1.00 Reference 1.00 Reference
 Health centre 0.32 0.10 to 1.00 0.39 0.13 to 1.24 0.61 0.44 to 0.87
 Regional/provincial/ university hospital 0.24 0.07 to 0.80 0.16 0.05 to 0.52 0.31 0.20 to 0.48
Region 0.897 0.183 0.042
 Africa 1.00 Reference 1.00 Reference 1.00 Reference
 Asia-Pacific 0.88 0.43 to 1.83 0.78 0.37 to 1.67 0.57 0.36 to 0.92
 Latin America 1.30 0.36 to 4.64 0.35 0.11 to 1.09 1.25 0.53 to 2.95
Open in a new tab

The estimates were derived from multivariable logistic regression models which included the following variables: level of integration, income level, TB burden, TPT training, level of care at the facility and region (National HIV prevalence was omitted due to collinearity). The results from the univariable models are shown in online supplemental table 4.

TB, tuberculosis; TPT, tuberculosis preventive therapy.

The most frequently reported barriers to TPT uptake were patient refusal (71, 41%), followed by insufficient drug availability or shortages (67, 39%). 48 clinics (28%) reported no barriers to TPT uptake (figure 3).

Figure 3. Proportion of HIV care clinics reporting barriers to TPT initiation. TPT, TB preventive therapy, TB, tuberculosis.

Figure 3

Open in a new tab

Available TPT regimens and associated factors

The 6-month isoniazid monotherapy TPT regimen was the most widely offered (155, 90%), followed by the 3- month once-weekly isoniazid-rifapentine regimen (110, 64%). Other short rifamycin-based regimens such as 3- month rifampicin monotherapy were available at 11 (6%) clinics (figure 4). The availability of TPT regimens stratified by region, TB burden, national HIV prevalence and by the level of HIV/TB service integration is shown in online supplemental figure 2. The use of any short-course rifamycin-based regimen was not clearly associated with clinic characteristics, including region, TB burden or country income level (online supplemental table 5).

Figure 4. Availability of TB preventive therapy regimens for adults and children at HIV care clinics, presented as proportions of clinics. INH, H, isoniazid; RIF, R, rifamycin; MDR, multidrug resistant; TB, tuberculosis.

Figure 4

Open in a new tab

Discussion

The prevention of active TB disease through TPT is crucial to the WHO’s ‘End TB Strategy’ and to global TB elimination efforts. Our survey of 178 HIV care clinics within the global IeDEA consortium assessed the implementation of TPT following the 2020 WHO guidelines recommending TPT for risk groups including PLWH and household contacts, as well as the use of shorter rifamycin-based TPT regimens. We found that TPT was available in nearly all surveyed clinics, yet there were gaps in implementation. Despite fully or partially integrated TB services being offered at the majority of participating HIV care clinics, more than a quarter of clinics did not offer TPT to PLWH who are at high risk of developing TB, more than a quarter did not offer it to household contacts of people with active TB, and more than two-thirds did not provide TPT to other at-risk populations. Shorter and more tolerable rifamycin-based TPT regimens were offered at three quarters of the clinics.

The efficacy of TPT in preventing the development of active TB has been shown,12 13 but implementation remains challenging.29,32 The effectiveness of TPT depends on appropriate identification of people at high risk who would benefit most, use of regimens of proven efficacy, and maximising adherence to and completion of treatment.33,35 We showed that TPT implementation varied across regions and healthcare settings. Furthermore, we observed a broad reliance on symptom-based screening to exclude TB before initiating TPT. Only a few sites reported using tuberculin skin tests and interferon-gamma release assays to determine TPT eligibility. This is in line with the WHO guidelines which recommend—but do not require—using such tests, and reflects previous evidence showing the challenges and costs associated with TB infection testing in high-TB-burden settings.30 36

Our data showed that a significant proportion of clinics did not offer TPT to the populations at the highest risk of developing TB, especially PLWH and household contacts of people diagnosed with TB, despite WHO recommendations.15 A previous study in South Africa also showed that TB screening and TPT initiation were rare among close contacts of confirmed TB patients.37 A study in Uganda reported good TB screening practices, but poor levels of TPT initiation among PLWH.38 Even though the added value of prescribing TPT to PLWH is widely accepted, our results confirmed the insufficient implementation and use of TPT among PLWH.39 40 These findings highlight difficulties in implementing TPT according to WHO recommendations, putting vulnerable people at greater risk of developing and transmitting TB, especially in places with high prevalence of HIV-associated TB. Although household contacts of people with TB are not the main target population of HIV clinics, they can be an important entry point for scaling up TPT services.

The majority (129, 75%) of clinics in our study offered shorter rifamycin-based TPT regimens, although mainly for adults. In the last IeDEA site assessment conducted in 2020 (before the COVID-19 pandemic’s impact on service delivery), 143 clinics (70%) reported providing TPT to individuals who screened negative for TB disease. Of those, less than 20% reported offering at least one rifamycin-based short-course regimen and less than 10% offered the 3-month regimen of isoniazid-rifapentine.41 Provision of 3HP, a short rifamycin-based regimen (3 months isoniazid/rifapentine) has increased more than sixfold to 64% in this study, reflecting global efforts to expand access to short-course TPT regimens. These rifamycin-based TPT regimens have been shown to improve patient adherence and reduce treatment-related adverse events, compared with isoniazid-containing regimens.42 43 Yet, drug–drug interactions between rifamycin-based TPT and some antiretroviral therapy regimens may need to be carefully considered.13 15 39 Overall, the expansion of shorter and less toxic TPT regimens follows growing recognition that TPT should be more patient-friendly, which is crucial for improving TPT uptake and completion rates.33 44 Beyond maintaining high levels of TPT initiation, loss to follow-up and TPT interruptions may hinder completion rates of TPT, which is another important indicator in the TB preventive cascade.17 45

Respondents in this study reported that the main barriers to TPT initiation were both individual (patient refusal) and institutional (drug shortages). Patient engagement is critical to the successful scale-up of TPT. Adopting a patient-centred approach will ensure that programmes are tailored to patient needs. Empowerment of patient representatives to provide input into TPT programmes will enhance the quality of care and ultimately improve participation. The growing number of therapeutic options available to patients also enables a more patient-centred approach to TPT.46 Furthermore, barriers at the healthcare-provision level, such as insufficient training of healthcare providers, lack of regulatory approval of newer regimens and supply chain inefficiencies, have been previously shown to impede TPT implementation.8 16 30

Our study has limitations. Although the analysis of our sample of HIV care clinics provides a broad overview of TPT implementation 3 years after the release of the 2020 WHO recommendations in a diverse set of clinics, including smaller and rural clinics, the HIV care clinics participating in IeDEA may not be fully representative of HIV care globally, which may limit the generalisability of our results. The survey responses did not include clinical practices of ART regimen prescription which may also influence the choice of TPT regimens. Comedications and drug–drug interactions at the individual level are an important aspect to consider.13 15 39 Finally, we did not examine the practices of individual clinicians towards prescribing TPT or patients’ perceptions of and adherence to TPT.

3 years after the release of updated WHO guidelines for the prevention of TB, most of IeDEA’s HIV clinics surveyed in Africa, the Asia-Pacific and Latin America and the Caribbean reported offering TPT, but its implementation only partly followed the latest WHO recommendations in place by then. However, efforts are needed to ensure that people who are at the highest risk of developing active TB receive TPT, particularly PLWH and close contacts of individuals with active TB. Our study highlights the importance of integrating HIV and TB services to improve TB infection diagnostic practices, improving TPT access for at-risk populations and increasing access to patient-friendly TPT regimens, which are essential for achieving the goals of the ‘End TB Strategy’.

Supplementary material

online supplemental table 1
bmjgh-11-1-s001.docx (1.2MB, docx)
DOI: 10.1136/bmjgh-2024-018469
online supplemental file 1
bmjgh-11-1-s002.docx (18KB, docx)
DOI: 10.1136/bmjgh-2024-018469

Acknowledgements

The following individuals led the development, design and implementation of IeDEA’s 2023 site assessment survey: Chad Achenbach, Ellen Brazier, Yanink Caro, Jessica Castilho, Stephany Duda, Leslie A Enane, Lukas Fenner, Esther Freeman, April D Kimmel, Mark Kuniholm, Kathryn Lancaster, Fernanda Maruri, Denis Nash, Angela Parcesepe and C William Wester. Site investigators, clinicians and data managers who distributed and completed the survey are listed by IeDEA region, below. The authors are grateful to all these individuals for their substantive contributions, which made this analysis possible.

Footnotes

Funding: This study was funded by National Institute of Allergy and Infectious Diseases (R24AI24872, U01AI069907, U01AI069911, U01AI069918, U01AI069919, U01AI069923, U01AI069924, U01AI096299).

Provenance and peer review: Not commissioned; externally peer reviewed.

Handling editor: Helen J Surana

Patient consent for publication: Not applicable.

Ethics approval: This study does not involve human participants. The collection of site-level survey data for this project was reviewed by the Vanderbilt University Institutional Review Board (USA) and given a non-research status (contact: irb@vanderbilt.edu).

Collaborators: On behalf of the IeDEA global consortium: ASIA-PACIFIC: Australia: K Petoumenos, M Law, A Kariminia, A Han, N Roth, L Burton, J Shapiro, K Watson, J Duffy, D Russell, T Flitcroft, DJ Templeton, LM Garton, D Sowden, R Teague, E Chow, J Ong, M Gunathilake, S Hall, K Thompson, J Hoy, M Bryant, S Price, J McMahon, N Ryder, G Sweeney, E Leprince, A Carr, A Hawkes, M O'Reilly, A D Smith, A Martin Redmond, S Benn, I Woolley, J O’Bryan, K Cisera, T Korman, C Thng, R Bopage. Cambodia: B Ngauv, V Khol, V Bun, C Pov. China (Hong Kong SAR): S Chan, MP Lee, TS Kwong. India: R Borse, H Prasad, V Mave, S Nimkar, N Kumarasamy, S Poongulali, S Pujari, K Joshi, S Gaikwad, A Chitalikar. Indonesia: IKA Somia, MS Utama, AAAY Gayatri, NMDD Sukmawati, DK Wati, IB Ramajaya, D Vedaswari, A Alam, R Wisaksana, P Achdiat, S Iskandar, E Yunihastuti, S Sundari, A Widhani, B Wicaksana, N Kurniati, D Muktiarti. Japan: J Tanuma, H Gatanaga, H Uemura, Y Koizumi. Malaysia: YM Gani, TK Heng, NA Misnan, SK Chidambaram, I Azwa, S Basri, RX Ng. Philippines: R Ditangco, MK Pasayan, ML Mationg, N Delgado. Singapore: D Loy, OT Ng, Z Ferdous. South Korea: JY Choi, JH Kim. Taiwan: HP Chen, PC Wu. Thailand: A Avihingsanon, HMS Lwin, C Wongvoranet, C Ruengpanyathip, S Kiertiburanakul, A Phuphuakrat, L Chumla, N Sanmeema, R Chaiwarith, J Praparattanapan, K Nuket, S Khuwuwan, P Kambua, S Pongprapass, J Limlertchareonwanit. Vietnam: TN Pham, DTH Nguyen, DT Nguyen, TT Nguyen, NCT Nguyen, CD Do, LT Nguyen, TT Doan, LV Nguyen, PH Nguyen, TTT Giang, TTT Huong, QT Du, TT Nguyen, TTT Trang, LAT Nguyen, QN Nguyen, VTT Duong, NDH Yen. Regional coordination and data management centers: AH Sohn, JL Ross, B Petersen, T Suwanlerk, MG Law, K Petoumenos, A Jiamsakul, D Rupasinghe, A Kariminia. CARIBBEAN, CENTRAL AND SOUTH AMERICA (CCASAnet): Argentina: Carina Cesar, Florencia Cahn, Valeria Fink, Nicolas Doudtchitzky. Brazil: Sandra Wagner Cardoso, Emilia Jalil, Brenda Hoagland, Carolina Coutinho, Flavia Gomes Faleiro Ferreira, Jorge Andrade Pinto, Daisy Maria Machado, Ana Isabel de Melo Pereira Monteiro, Paulo Abrão. Chile: Claudia M. Cortes. Haiti: Vanessa Rouzier. Honduras: Marco Tulio Luque, Magda Chavez, Diana Varela, Isaura Herrera. Mexico: Brenda Crabtree-Ramirez, Jessica Mejía Castrejon, Alvaro Lopez Iniguez, Rodrigo Ville Benavides. Peru: Fernando Mejía, Eduardo Gotuzzo. Regional coordination and data management center: Jessica L. Castilho, Stephany Duda, Fernanda Maruri, C. William Wester. CENTRAL AFRICA IeDEA: Burundi: Pelagie Nimbona, Gakima Devote, Eliane Hatungimana, Sylvain Pagnol Niragira, Thierry Nahimana, Olive Niyonkuru, Gloria Ingabire, Appolonie Nizigiyimana, Calinie Keza, Emerentienne Gahimbare, Ella-Ange Kazigamwa, Nadine Nisana, Cynthia Hitimana, Jeanine Niyonzima, Christella Twizere, Annabelle Niyongabo, Jean Marie Ntibigarura, Zacharie Ndizeye. Cameroon: Esther N. Neba, Denis Nsame, Ajeh Bazil, Vera Veyieeneneng, Djenabou Amadou, Eric Walter Pefura, Nicoline Ndi, Eric Ngassam, Philis Fon, Annerreke Nyenti, Judith Nasah Lainsi, Adiah Mary Akama, Anastase Dzudie, Peter Vanes Ebasone, Gabriel Mabou. Democratic Republic of the Congo: Simon Kombela, Nzungani Jean-Paul, Patricia Vangu Matondo Lelo, Faustin Kitetele, Catherine Akele, Georgine Luzimbu, Eric Kiambi Makamba, Mpongo Makinda Thethe, Matthieu Musiku. Republic of Congo: Dominique Mahambou Nsonde, Arcel Christ Massamba Ndala, Rocide Moukouba, Merlin Diafouka, Adolphe Mafoua, Nadège Teke Bagamboula, Ursula Ingride Koukha, Nadine Mahinga. Rwanda: Jules Onesphore Igirimbabazi, Esperance Mujawimana, Fidele Ntarambirwa, Nicole Ayinkamiye, Ernestine Igizeneza, Providence Uwineza, Yvonne Tuyishimire, Elizaphan Nzabahimana, Emmanuel Ndamijimana, Janviere Mukankubana, Jean Baptiste Habumuremyi, Françoise Mugwaneza, Marie Alice Liliane Cyuzuzo, Marie Louise Nyiraneza, Jean Claude Habanabashaka, Sr Marie Louise Nyiransabimana, Josephine Ayinkamiye, Dieudonne Niyoyita, Liliane Tuyisenge, Rose Kwitonda, Jeanne d'Arc Mukakarangwa, Sr Epiphanie Mukashyaka, Fabien Gahunzire, Theophilla Niyigobaka, Christian Shyaka, Marie Victoire Uwambaje, Veneranda Mukarwego, Louis Gataha, Bonheur Uwakijijwe, Olive Uwamahoro, Jean d’ Amour Niyonzima, Marie Grace Ingabire, Patrick Maniragaba, Deo Gratias Mugisha, Berthilde Uwumaliya, Viateur Haburemyi, Beatrice Uwimana, Jules Ndumuhire, Sylverie Sanaso, Ruth Nyiramahirwe, Vincent Habimana, Gerald Bunani, Gilbert Maniriho, Innocent Sangwa, Fred Muyango, Wilbrold Habiyaremye, Angelique Murerwanimana, Marie Claire Uwamahoro, Olive Uwamahoro, Esperance Tuyishime, Olive Mukahirwa, Albertine Bonheur, Eugenie Mukashyaka, Florence Umugiraneza, Rosine Feza, Marie Denise Uwamahoro, Chantal Benekigeri, Jacqueline Musaninyange, Chantal Dusabe, Rose Kagaju, Shadrack Niyibizi, Marie Rosine Umugwaneza, Alex Buteera, Eric Seruyange, Thierry Habiryayo, Gad Murenzi, Gallican Kubwimana, Ben Muhoza, Athanase Munyaneza. Regional coordination and data management center: Ellen Brazier, Denis Nash. EAST AFRICA IeDEA: Kenya: Mildred Kweyu, Linda Alosa, Doris Tutu Pepela, Victoria Akinyi Amonde, Moses Obuya, Kennedy Anyira Wawire, Beatrice Mayo, Josephine Mukoya, Saumu Namiso, Chirchir Benard, Levin Zeph Juma, Hillary Kiptoo, Meshack Murto, Lydia Arusei, Ann Namae, Hosea Maritim, Wilson Kirui, Fentra Sakong, Maureen Mutiembu, Moses Delewa, Sarah Cheptoo, Titus C. Rutto, Nicholas Kosgei, Felix Ambula, Josephine Chebet, Philemon Matutu, Monica Wanza, Rose Sibweche, Judith Jepyegon Kimelil, George Wafula Oduori, Kenneth Malika, Renson Ekemesi, Sadam Odhiambo, Nobrah M. Mutuku, Lydia Oloo, Koech Canicious, Wycliffe Omondi Abwao, Sarah Obatsa, Felix Ochieng, John Moracha Ogoti, Dolphine Nyaboke, Nancy Nafula, Pamela Emukule, Lameck Diero, Edwin Sang, Cosmas Apaka, Irene Wafula, John Chirchir, Violet Kisaka, Murutu J, Margaret Birgen, Janet Borosio, Abraham Kiptum Kosgei, Paul Ouma, Seth Odero, Sarah Obatsa, William Mayamba, Gabriel Netwon Alubala, Lithy David, Bonface Omalla, Cosolata Akoth, Bonface Kibet, Nelly Owiti, Lilian Ndakalu, Derick Simiyu Njofu, Elisha Chelal, Sunyai Nancy, Ariya Patrick, Ruth Rotich, Maureen Ayieko, Joyce Jelagat, Kipruto Ednah, Valentine Chebor, Victor Wezonga, Harrison Kibet, Collins Kipsang. Tanzania: Denna Michael, Charles Nyaga, Elcard Nunda, Regina Alphonce, Rita Lyamuya, Paul Kazyoba, Lilian Mkombachepa, Godlovenes Rubega, Jerome Lwali, Happiness Rutakulemberwa, Ruth Kamugwawa, Nicolaus Nyendikuu. Uganda: Nnakakawa Cissy, Ritah Namagogwe, Ahmed Ddungu, Barbara Castelnuovo, Marion Achieng, John Michael Matovu, Nanziri Allen, Nassanga Sarah J, Kyosimiire Norah, Daniel Mujunu, Nabwire Scovia, Luqman Sulaiman, Haruna, Innocent Kakeeto, Emmanuel Ssekyeru, Joseph Muleebwa, Irene Nayiga, Joan Namayanja, Brendah Nalutaaya, Sara Namembe, Esther Nakamanya, Patricia Nakato, Herbert Ssenyonga, Ruth Nazziwa Coleta, Proscovia Nantale, Joan Nayiga, Ssewanyana Tom, Namukisa Cossy, Kigozi Boniface, Rosemary Nassolo, Jane Tukashaba, Ritah Nalubega, Sandra Nabagirinya, Sylvia Nalwanga, Jumulo Nicholas, Zziwa Abiyasali, Agaba Ajaara, Julius Patrick Senoga, Kisirisa Claire, Kayovu Robert, Kamukama Brenda, Namirembe Rosemary, Nicholas Ssewankambwe, Ndagano Mercy, Semerita Muhindo, Bugembe John Nyanzi, Charles Kasozi, Phoebe Mutenyo, Matthew Ssemakadde, Winnie Muyindike, Denis Nansera, Bronia Mwiine, Patience Kusemerewa, Nakabiito Safina, Kibalama Donozio, Nalwoga Prossy, Naksaenge Cissy, Nakuya Juliet, Fred Nalugoda, Anthony Ndyanabo, Nakawooya Hadijja, Magezi Ibrahim, Orit Robert. Regional coordination and data management center: Kara Wools-Kaloustian, Constantin Yiannoutsos, Aggrey Semeere, Bev Musick. IeDEA NORTH AMERICAN AIDS COHORT COLLABORATION ON RESEARCH AND DESIGN (NA-ACCORD): Canada: John Gill, Marina Klein, Costas Pexos. United States of America: Michael Horberg, Cynthia S Firnhaber, Jonathan Colasanti, Julia Fleming, Ami Multani, Amanda Eldredge, Cynthia Mayer, Julie Pasternak, Mitchell Luu, Frank Palella, Ank Nijhawan, Shelly J Ramos Torres, Lymary Velazquez, Kathia Ocasio, Celestino Flores Lourdes Santiago, Angel Mayor, Jane Esteves, Rita Kelly, Jack Fuhrer, Ellen Tedaldi, Laura Bamford, Andrea Wendrow, Richard Novak, Claire Farel, Mari Kitahata, Anna Person, Theo W. Hodge Jr, Matthew B. Goetz, Greer A. Burkholder, Graham Smith, Mona Loutfy. Regional coordination and data management center: Keri Althoff, Richard Moore, Aimee Freeman. IeDEA SOUTHERN AFRICA: Lesotho: Monkoe Bereng, Richard Kenyata, Tlohang Qhobela, Matlotliso Maqhai, Masefako Liotlo, Lerato Lebakeng. Malawi: Jacqueline Huwa, Mwagomba Crust, Damba Douglas, Ganizani Malata, Jacqueline Huwa, Eric Mtemang'ombe. Mozambique: Idiovino Rafael. South Africa: Zakhona Ndlovu, Nosisa Sipambo, Geoffrey Fatti, Nontando Xaba, Bongi Cele, Sibongokuhle Ntombela, Jonathan Euvrard, Brian Eley, Hans Prozesky, Thalia Ferreira, Nicola Van Dongen, Cuma Koncwana, Chantel Schreuder. Zambia: Gerald Mungwa, Gift Chongo, Precious Kakvugu, Harriet Chabala, Fiennel Moonde, Leah Shapi, Dora Mwaba, Josephine C Sithole, Derrick Mwenda Filumba. Zimbabwe: Kumbirai Pise Quarter, Cleophas Chimbetete. Regional coordination and data management center: Morna Cornell, Per von Groote, Mary-Ann Davies, Matthias Egger. IeDEA WEST AFRICA: Benin: Gael Ayihounton, Tounkara Lidie, Bokossa Laurelle, Zannou Marcel Djimon, Léhila Bagnan Tossa. Burkina Faso: Armel Poda, Gbolo Pooda, Caroline Yonaba. Côte d’Ivoire: Eugène Messou, N'Gbeche Marie Sylvie, Albert Kla Minga, Stéphane Kouadio N'Goran, Henri Chenal, Kouakou Kouadio, Daple Beugre N'Guessan Jacques, Amorissani Folquet, Eboua Tanoh. Ghana: Joycelyn Assimeng Dame, Islynn Gloria Aggrey, Vincent Ganu. Mali: Yacouba Aba Coulibaly. Nigeria: Oliver Ezechi, Agatha N. David, Abdulrasheed A. Oba, Abdulrasheed. Togo: Elom Takassi, Mensah Ephrem. Regional coordination and data management center: Thierry Tiendrebeogo, Karen Malateste, Antoine Jaquet, Valeriane Leroy.

Map disclaimer: The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Contributor Information

The IeDEA global consortium:

K Petoumenos, M Law, A Kariminia, A Han, N Roth, L Burton, J Shapiro, K Watson, J Duffy, D Russell, T Flitcroft, DJ Templeton, LM Garton, D Sowden, R Teague, E Chow, J Ong, M Gunathilake, S Hall, K Thompson, J Hoy, M Bryant, S Price, J McMahon, N Ryder, G Sweeney, E Leprince, A Carr, A Hawkes, M O'Reilly, A D Smith, A Martin Redmond, S Benn, I Woolley, J O’Bryan, K Cisera, T Korman, C Thng, R Bopage, B Ngauv, V Khol, V Bun, C Pov, S Chan, MP Lee, TS Kwong, R Borse, H Prasad, V Mave, S Nimkar, N Kumarasamy, S Poongulali, S Pujari, K Joshi, S Gaikwad, A Chitalikar, IKA Somia, MS Utama, AAAY Gayatri, NMDD Sukmawati, DK Wati, IB Ramajaya, D Vedaswari, A Alam, R Wisaksana, P Achdiat, S Iskandar, E Yunihastuti, S Sundari, A Widhani, B Wicaksana, N Kurniati, D Muktiarti, J Tanuma, H Gatanaga, H Uemura, Y Koizumi, YM Gani, TK Heng, NA Misnan, SK Chidambaram, I Azwa, S Basri, RX Ng, R Ditangco, MK Pasayan, ML Mationg, N Delgado, D Loy, OT Ng, Z Ferdous, JY Choi, JH Kim, HP Chen, PC Wu, A Avihingsanon, HMS Lwin, C Wongvoranet, C Ruengpanyathip, S Kiertiburanakul, A Phuphuakrat, L Chumla, N Sanmeema, R Chaiwarith, J Praparattanapan, K Nuket, S Khuwuwan, P Kambua, S Pongprapass, J Limlertchareonwanit, TN Pham, DTH Nguyen, DT Nguyen, TT Nguyen, NCT Nguyen, CD Do, LT Nguyen, TT Doan, LV Nguyen, PH Nguyen, TTT Giang, TTT Huong, QT Du, TT Nguyen, TTT Trang, LAT Nguyen, QN Nguyen, VTT Duong, NDH Yen, AH Sohn, JL Ross, B Petersen, T Suwanlerk, MG Law, K Petoumenos, A Jiamsakul, D Rupasinghe, A Kariminia, Carina Cesar, Florencia Cahn, Valeria Fink, Nicolas Doudtchitzky, Sandra Wagner Cardoso, Emilia Jalil, Brenda Hoagland, Carolina Coutinho, Flavia Gomes Faleiro Ferreira, Jorge Andrade Pinto, Daisy Maria Machado, Ana Isabel de, Melo Pereira Monteiro, Paulo Abrão, Claudia M. Cortes, Vanessa Rouzier, Marco Tulio Luque, Magda Chavez, Diana Varela, Isaura Herrera, Brenda Crabtree-Ramirez, Jessica Mejía Castrejon, Alvaro Lopez Iniguez, Rodrigo Ville Benavides, Fernando Mejía, Eduardo Gotuzzo, Jessica L. Castilho, Stephany Duda, Fernanda Maruri, C. William Wester, Pelagie Nimbona, Gakima Devote, Eliane Hatungimana, Sylvain Pagnol Niragira, Thierry Nahimana, Olive Niyonkuru, Gloria Ingabire, Appolonie Nizigiyimana, Calinie Keza, Emerentienne Gahimbare, Ella-Ange Kazigamwa, Nadine Nisana, Cynthia Hitimana, Jeanine Niyonzima, Christella Twizere, Annabelle Niyongabo, Jean Marie Ntibigarura, Zacharie Ndizeye, Esther N. Neba, Denis Nsame, Ajeh Bazil, Djenabou Amadou Vera Veyieeneneng, Eric Walter Pefura, Nicoline Ndi, Eric Ngassam, Philis Fon, Annerreke Nyenti, Judith Nasah Lainsi, Adiah Mary Akama, Anastase Dzudie, Peter Vanes Ebasone, Gabriel Mabou, Simon Kombela, Nzungani Jean-Paul, Patricia Vangu Matondo Lelo, Faustin Kitetele, Catherine Akele, Georgine Luzimbu, Eric Kiambi Makamba, Mpongo Makinda Thethe, Matthieu Musiku, Dominique Mahambou Nsonde, Arcel Christ Massamba Ndala, Rocide Moukouba, Merlin Diafouka, Adolphe Mafoua, Nadège Teke Bagamboula, Ursula Ingride Koukha, Nadine Mahinga, Jules Onesphore Igirimbabazi, Esperance Mujawimana, Fidele Ntarambirwa, Nicole Ayinkamiye, Ernestine Igizeneza, Providence Uwineza, Yvonne Tuyishimire, Elizaphan Nzabahimana, Emmanuel Ndamijimana, Janviere Mukankubana, Jean Baptiste Habumuremyi, Françoise Mugwaneza, Marie Alice Liliane Cyuzuzo, Marie Louise Nyiraneza, Jean Claude Habanabashaka, SrMarie Louise Nyiransabimana, Josephine Ayinkamiye, Dieudonne Niyoyita, Liliane Tuyisenge, Rose Kwitonda, Jeanne dArc Mukakarangwa, SrEpiphanie Mukashyaka, Fabien Gahunzire, Theophilla Niyigobaka, Christian Shyaka, Marie Victoire Uwambaje, Veneranda Mukarwego, Louis Gataha, Bonheur Uwakijijwe, Olive Uwamahoro, Jean d’ Amour Niyonzima, Marie Grace Ingabire, Patrick Maniragaba, Deo Gratias Mugisha, Berthilde Uwumaliya, Viateur Haburemyi, Beatrice Uwimana, Jules Ndumuhire, Sylverie Sanaso, Ruth Nyiramahirwe, Vincent Habimana, Gerald Bunani, Gilbert Maniriho, Innocent Sangwa, Fred Muyango, Wilbrold Habiyaremye, Angelique Murerwanimana, Marie Claire Uwamahoro, Olive Uwamahoro, Esperance Tuyishime, Olive Mukahirwa, Albertine Bonheur, Eugenie Mukashyaka, Florence Umugiraneza, Rosine Feza, Marie Denise Uwamahoro, Chantal Benekigeri, Jacqueline Musaninyange, Chantal Dusabe, Rose Kagaju, Shadrack Niyibizi, Marie Rosine Umugwaneza, Alex Buteera, Eric Seruyange, Thierry Habiryayo, Gad Murenzi, Gallican Kubwimana, Athanase Munyaneza Ben Muhoza, Ellen Brazier, Denis Nash, Mildred Kweyu, Linda Alosa, Doris Tutu Pepela, Victoria Akinyi Amonde, Moses Obuya, Kennedy Anyira Wawire, Beatrice Mayo, Josephine Mukoya, Saumu Namiso, Chirchir Benard, Levin Zeph Juma, Hillary Kiptoo, Meshack Murto, Lydia Arusei, Ann Namae, Hosea Maritim, Wilson Kirui, Fentra Sakong, Maureen Mutiembu, Moses Delewa, Sarah Cheptoo, Titus C. Rutto, Nicholas Kosgei, Felix Ambula, Josephine Chebet, Philemon Matutu, Monica Wanza, Rose Sibweche, Judith Jepyegon Kimelil, George Wafula Oduori, Kenneth Malika, Renson Ekemesi, Sadam Odhiambo, Nobrah M. Mutuku, Lydia Oloo, Koech Canicious, Wycliffe Omondi Abwao, Sarah Obatsa, Felix Ochieng, John Moracha Ogoti, Dolphine Nyaboke, Nancy Nafula, Pamela Emukule, Lameck Diero, Edwin Sang, Cosmas Apaka, Irene Wafula, John Chirchir, Violet Kisaka, J Murutu, Margaret Birgen, Janet Borosio, Abraham Kiptum Kosgei, Paul Ouma, Seth Odero, Sarah Obatsa, William Mayamba, Gabriel Netwon Alubala, Lithy David, Bonface Omalla, Cosolata Akoth, Bonface Kibet, Nelly Owiti, Lilian Ndakalu, Derick Simiyu Njofu, Elisha Chelal, Sunyai Nancy, Ariya Patrick, Ruth Rotich, Maureen Ayieko, Joyce Jelagat, Kipruto Ednah, Valentine Chebor, Victor Wezonga, Harrison Kibet, Collins Kipsang, Denna Michael, Charles Nyaga, Elcard Nunda, Regina Alphonce, Rita Lyamuya, Paul Kazyoba, Lilian Mkombachepa, Godlovenes Rubega, Jerome Lwali, Happiness Rutakulemberwa, Ruth Kamugwawa, Nicolaus Nyendikuu, Nnakakawa Cissy, Ritah Namagogwe, Ahmed Ddungu, Barbara Castelnuovo, Marion Achieng, John Michael Matovu, Nanziri Allen, J Nassanga Sarah, Kyosimiire Norah, Daniel Mujunu, Nabwire Scovia, Luqman Sulaiman, Innocent Kakeeto Haruna, Emmanuel Ssekyeru, Joseph Muleebwa, Irene Nayiga, Joan Namayanja, Brendah Nalutaaya, Sara Namembe, Esther Nakamanya, Patricia Nakato, Herbert Ssenyonga, Ruth Nazziwa Coleta, Proscovia Nantale, Joan Nayiga, Ssewanyana Tom, Namukisa Cossy, Kigozi Boniface, Rosemary Nassolo, Jane Tukashaba, Ritah Nalubega, Sandra Nabagirinya, Sylvia Nalwanga, Jumulo Nicholas, Zziwa Abiyasali, Agaba Ajaara, Julius Patrick Senoga, Kisirisa Claire, Kayovu Robert, Kamukama Brenda, Namirembe Rosemary, NIcholas Ssewankambwe, Ndagano Mercy, Semerita Muhindo, Bugembe John Nyanzi, Charles Kasozi, Phoebe Mutenyo, Matthew Ssemakadde, Winnie Muyindike, Denis Nansera, Bronia Mwiine, Patience Kusemerewa, Nakabiito Safina, Kibalama Donozio, Nalwoga Prossy, Naksaenge Cissy, Nakuya Juliet, Fred Nalugoda, Anthony Ndyanabo, Nakawooya Hadijja, Magezi Ibrahim, Orit Robert, Kara Wools-Kaloustian, Constantin Yiannoutsos, Aggrey Semeere, Bev Musick, John Gill, Marina Klein, Costas Pexos, Michael Horberg, Cynthia S Firnhaber, Jonathan Colasanti, Julia Fleming, Ami Multani, Amanda Eldredge, Cynthia Mayer, Julie Pasternak, Mitchell Luu, Frank Palella, Ank Nijhawan, Shelly J Ramos Torres, Lymary Velazquez, Kathia Ocasio, Celestino Flores Lourdes Santiago, Angel Mayor, Jane Esteves, Rita Kelly, Jack Fuhrer, Ellen Tedaldi, Laura Bamford, Andrea Wendrow, Richard Novak, Claire Farel, Mari Kitahata, Anna Person, Theo W. Hodge, Matthew B. Goetz, Greer A. Burkholder, Graham Smith, Mona Loutfy, Keri Althoff, Richard Moore, Aimee Freeman, Monkoe Bereng, Richard Kenyata, Tlohang Qhobela, Matlotliso Maqhai, Masefako Liotlo, Lerato Lebakeng, Jacqueline Huwa, Mwagomba Crust, Damba Douglas, Ganizani Malata, Jacqueline Huwa, Eric Mtemang'ombe, Idiovino Rafael, Zakhona Ndlovu, Nosisa Sipambo, Geoffrey Fatti, Nontando Xaba, Bongi Cele, Sibongokuhle Ntombela, Jonathan Euvrard, Brian Eley, Hans Prozesky, Thalia Ferreira, Nicola Van Dongen, Cuma Koncwana, Chantel Schreuder, Gerald Mungwa, Gift Chongo, Precious Kakvugu, Harriet Chabala, Fiennel Moonde, Leah Shapi, Dora Mwaba, Josephine C Sithole, Derrick Mwenda Filumba, Kumbirai Pise Quarter, Cleophas Chimbetete, Morna Cornell, Per von Groote, Mary-Ann Davies, Matthias Egger, Gael Ayihounton, Tounkara Lidie, Bokossa Laurelle, Zannou Marcel Djimon, Léhila Bagnan Tossa, Armel Poda, Gbolo Pooda, Caroline Yonaba, Eugène Messou, N'Gbeche Marie Sylvie, Albert Kla Minga, Stéphane Kouadio, Henri Chenal N'Goran, Kouakou Kouadio, Daple Beugre, N'Guessan Jacques, Amorissani Folquet, Eboua Tanoh, Joycelyn Assimeng Dame, Islynn Gloria Aggrey, Vincent Ganu, Yacouba Aba Coulibaly, Oliver Ezechi, Agatha N. David, Abdulrasheed A. Oba, Elom Takassi Abdulrasheed, Mensah Ephrem, Thierry Tiendrebeogo, Karen Malateste, Antoine Jaquet, and Valeriane Leroy

Data availability statement

Data are available on reasonable request and after evaluation. The code used in the presented analyses is available at https://github.com/schmutzre/TPT_survey.

References

  • 1.Houben R, Dodd PJ. The Global Burden of Latent Tuberculosis Infection: A Re-estimation Using Mathematical Modelling. PLoS Med. 2016;13:e1002152. doi: 10.1371/journal.pmed.1002152. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Dodd PJ, Gardiner E, Coghlan R, et al. Burden of childhood tuberculosis in 22 high-burden countries: a mathematical modelling study. Lancet Glob Health. 2014;2:e453–9. doi: 10.1016/S2214-109X(14)70245-1. [DOI] [PubMed] [Google Scholar]
  • 3.Getahun H, Matteelli A, Chaisson RE, et al. Latent Mycobacterium tuberculosis infection. N Engl J Med. 2015;372:2127–35. doi: 10.1056/NEJMra1405427. [DOI] [PubMed] [Google Scholar]
  • 4.Rangaka MX, Wilkinson RJ, Boulle A, et al. Isoniazid plus antiretroviral therapy to prevent tuberculosis: a randomised double-blind, placebo-controlled trial. The Lancet. 2014;384:682–90. doi: 10.1016/S0140-6736(14)60162-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.World Health Organization Global tuberculosis report 2024. [18-Nov-2024]. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2024 Available. Accessed.
  • 6.Ryckman T, Weiser J, Gombe M, et al. Impact and cost-effectiveness of short-course tuberculosis preventive treatment for household contacts and people with HIV in 29 high-incidence countries: a modelling analysis. Lancet Glob Health. 2023;11:e1205–16. doi: 10.1016/S2214-109X(23)00251-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Martinez L, Cords O, Horsburgh CR, et al. The risk of tuberculosis in children after close exposure: a systematic review and individual-participant meta-analysis. The Lancet. 2020;395:973–84. doi: 10.1016/S0140-6736(20)30166-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Majumdar SS, Triasih R, Graham SM. Scaling up tuberculosis preventive therapy for contacts in high transmission settings. Lancet Glob Health. 2020;8:e617–8. doi: 10.1016/S2214-109X(20)30133-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Whalen CC, Johnson JL, Okwera A, et al. A Trial of Three Regimens to Prevent Tuberculosis in Ugandan Adults Infected with the Human Immunodeficiency Virus. N Engl J Med . 1997;337:801–8. doi: 10.1056/NEJM199709183371201. [DOI] [PubMed] [Google Scholar]
  • 10.Swindells S, Ramchandani R, Gupta A, et al. One Month of Rifapentine plus Isoniazid to Prevent HIV-Related Tuberculosis. N Engl J Med. 2019;380:1001–11. doi: 10.1056/NEJMoa1806808. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Sterling TR, Villarino ME, Borisov AS, et al. Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med. 2011;365:2155–66. doi: 10.1056/NEJMoa1104875. [DOI] [PubMed] [Google Scholar]
  • 12.Uppal A, Rahman S, Campbell JR, et al. Economic and modeling evidence for tuberculosis preventive therapy among people living with HIV: A systematic review and meta-analysis. PLoS Med. 2021;18:e1003712. doi: 10.1371/journal.pmed.1003712. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Yanes-Lane M, Ortiz-Brizuela E, Campbell JR, et al. Tuberculosis preventive therapy for people living with HIV: A systematic review and network meta-analysis. PLoS Med. 2021;18:e1003738. doi: 10.1371/journal.pmed.1003738. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Zhu J, Lyatuu G, Sudfeld CR, et al. Re-evaluating the health impact and cost-effectiveness of tuberculosis preventive treatment for modern HIV cohorts on antiretroviral therapy: a modelling analysis using data from Tanzania. Lancet Glob Health. 2022;10:e1646–54. doi: 10.1016/S2214-109X(22)00372-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.World Health Organization WHO consolidated guidelines on tuberculosis: module 1: prevention: tuberculosis preventive treatment. 2020. [15-Jul-2022]. https://www.who.int/publications-detail-redirect/9789240001503 Available. Accessed. [PubMed]
  • 16.Melgar M, Shiraishi RW, Tende C, et al. Assessment of the tuberculosis case-finding and prevention cascade among people living with HIV in Zambia - 2018: a cross-sectional cluster survey. BMC Public Health. 2021;21:859. doi: 10.1186/s12889-021-10929-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Bastos ML, Melnychuk L, Campbell JR, et al. The latent tuberculosis cascade-of-care among people living with HIV: A systematic review and meta-analysis. PLoS Med. 2021;18:e1003703. doi: 10.1371/journal.pmed.1003703. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Grimsrud A, Wilkinson L. Acceleration of differentiated service delivery for HIV treatment in sub-Saharan Africa during COVID-19. J Int AIDS Soc. 2021;24:e25704. doi: 10.1002/jia2.25704. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Ballif M, Banholzer N, Perrig L, et al. The long-term impact of the COVID-19 pandemic on tuberculosis care and infection control measures in anti-retroviral therapy (ART) clinics in low- and middle-income countries: a multiregional site survey in Asia and Africa. BMJ Glob Health. 2025;10:e017828. doi: 10.1136/bmjgh-2024-017828. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Brazier E, Maruri F, Wester CW, et al. Design and implementation of a global site assessment survey among HIV clinics participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium. PLoS One. 2023;18:e0268167. doi: 10.1371/journal.pone.0268167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Chammartin F, Dao Ostinelli CH, Anastos K, et al. International epidemiology databases to evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012-2019. BMJ Open. 2020;10:e035246. doi: 10.1136/bmjopen-2019-035246. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81. doi: 10.1016/j.jbi.2008.08.010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208. doi: 10.1016/j.jbi.2019.103208. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.World Bank World Bank Country and Lending Groups – World Bank Data Help Desk. [28-Jun-2024]. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups Available. Accessed.
  • 25.HIV estimates with uncertainty bounds 1990-Present. [10-Jul-2024]. https://www.unaids.org/en/resources/documents/2023/HIV_estimates_with_uncertainty_bounds_1990-present Available. Accessed.
  • 26.High Burden Countries for Tuberculosis | Stop TB Partnership. [10-Jul-2024]. https://www.stoptb.org/securing-quality-tb-care-all/high-burden-countries-tuberculosis Available. Accessed.
  • 27.Zürcher K, Cox SR, Ballif M, et al. Integrating services for HIV and multidrug-resistant tuberculosis: A global cross-sectional survey among ART clinics in low- and middle-income countries. PLOS Glob Public Health . 2022;2:e0000180. doi: 10.1371/journal.pgph.0000180. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.The R Project for Statistical Computing. https://www.R-project.org/ Available.
  • 29.Naqvi S, Cantu Y, Ong Uti S, et al. Successes and challenges of latent TB screening and treatment in a high-prevalence US region. Int J Tuberc Lung Dis. 2022;26:720–6. doi: 10.5588/ijtld.21.0454. [DOI] [PubMed] [Google Scholar]
  • 30.Faust L, Ruhwald M, Schumacher S, et al. How are high burden countries implementing policies and tools for latent tuberculosis infection? A survey of current practices and barriers. Health Sci Rep . 2020;3:e158. doi: 10.1002/hsr2.158. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Alsdurf H, Hill PC, Matteelli A, et al. The cascade of care in diagnosis and treatment of latent tuberculosis infection: a systematic review and meta-analysis. Lancet Infect Dis. 2016;16:1269–78. doi: 10.1016/S1473-3099(16)30216-X. [DOI] [PubMed] [Google Scholar]
  • 32.Meintjes G, Maartens G. HIV-Associated Tuberculosis. N Engl J Med. 2024;391:343–55. doi: 10.1056/NEJMra2308181. [DOI] [PubMed] [Google Scholar]
  • 33.Yuen CM, Kurbatova EV, Tupasi T, et al. Association between Regimen Composition and Treatment Response in Patients with Multidrug-Resistant Tuberculosis: A Prospective Cohort Study. PLoS Med. 2015;12:e1001932. doi: 10.1371/journal.pmed.1001932. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Patel AR, Campbell JR, Sadatsafavi M, et al. Burden of non-adherence to latent tuberculosis infection drug therapy and the potential cost-effectiveness of adherence interventions in Canada: a simulation study. BMJ Open. 2017;7:e015108. doi: 10.1136/bmjopen-2016-015108. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Migliori GB, Wu SJ, Matteelli A, et al. Clinical standards for the diagnosis, treatment and prevention of TB infection. int j tuberc lung dis . 2022;26:190–205. doi: 10.5588/ijtld.21.0753. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Van Ginderdeuren E, Bassett J, Hanrahan CF, et al. Gaps in the tuberculosis preventive therapy care cascade in children in contact with TB. Paediatr Int Child Health. 2021;41:237–46. doi: 10.1080/20469047.2021.1971360. [DOI] [PubMed] [Google Scholar]
  • 37.van de Water BJ, Meyer TN, Wilson M, et al. TB prevention cascade at a district hospital in rural Eastern Cape, South Africa. Public Health Action. 2021;11:97–100. doi: 10.5588/pha.20.0055. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Kalema N, Semeere A, Banturaki G, et al. Gaps in TB preventive therapy for persons initiating antiretroviral therapy in Uganda: an explanatory sequential cascade analysis. int j tuberc lung dis . 2021;25:388–94. doi: 10.5588/ijtld.20.0956. [DOI] [PubMed] [Google Scholar]
  • 39.González Fernández L, Casas EC, Singh S, et al. New opportunities in tuberculosis prevention: implications for people living with HIV. J Int AIDS Soc. 2020;23:e25438. doi: 10.1002/jia2.25438. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Baloyi DP, Anthony MG, Meyerson KA, et al. Reasons for poor uptake of TB preventive therapy in South Africa. Public Health Action. 2022;12:159–64. doi: 10.5588/pha.22.0030. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Shearer K, Cox SR, Yotebieng M, et al. TB preventive therapy (TPT) service delivery at HIV clinics: results from a global cross-sectional survey within the International epidemiology Databases to Evaluate AIDS (IeDEA) Consortium. 2022. [10-Oct-2024]. https://programme.aids2022.org/Abstract/Abstract/?abstractid=7608 Available. Accessed.
  • 42.Global tuberculosis report 2023. [13-Feb-2024]. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2023 Available. Accessed.
  • 43.Winters N, Belknap R, Benedetti A, et al. Completion, safety, and efficacy of tuberculosis preventive treatment regimens containing rifampicin or rifapentine: an individual patient data network meta-analysis. Lancet Respir Med. 2023;11:782–90. doi: 10.1016/S2213-2600(23)00096-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Myburgh H, Baloyi D, Loveday M, et al. A scoping review of patient-centred tuberculosis care interventions: Gaps and opportunities. PLOS Glob Public Health. 3:e0001357. doi: 10.1371/journal.pgph.0001357. n.d. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Barss L, Moayedi-Nia S, Campbell JR, et al. Interventions to reduce losses in the cascade of care for latent tuberculosis: a systematic review and meta-analysis. int j tuberc lung dis. 2020;24:100–9. doi: 10.5588/ijtld.19.0185. [DOI] [PubMed] [Google Scholar]
  • 46.Fox GJ, Nguyen TA, Coleman M, et al. Implementing tuberculosis preventive treatment in high-prevalence settings. Int J Infect Dis. 2021;113 Suppl 1:S13–5. doi: 10.1016/j.ijid.2021.02.094. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

online supplemental table 1
bmjgh-11-1-s001.docx (1.2MB, docx)
DOI: 10.1136/bmjgh-2024-018469
online supplemental file 1
bmjgh-11-1-s002.docx (18KB, docx)
DOI: 10.1136/bmjgh-2024-018469

Data Availability Statement

Data are available on reasonable request and after evaluation. The code used in the presented analyses is available at https://github.com/schmutzre/TPT_survey.

Articles from BMJ Global Health are provided here courtesy of BMJ Publishing Group

RESOURCES