Determinants of drop-offs in the targeted universal tuberculosis testing care cascade among people with HIV in rural and urban facilities in South Africa
1
Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
2
National Department of Health, Pretoria, South Africa
3
Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, United States
4
Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Targeted Universal Tuberculosis Testing (TUTT) is essential for early tuberculosis (TB) detection among people with HIV (PWH); however, drop-offs at key cascade stages limit its effectiveness. This study examines determinants of drop-offs at three stages: Xpert testing, TB treatment initiation, and completion.
METHODS:
We conducted a retrospective analysis of routinely collected data in fiscal year 2022 from PWH on antiretroviral therapy (ART) in rural and urban facilities in KwaZulu-Natal, South Africa. Logistic regression identified determinants of drop-offs.
RESULTS:
Among 104 859 PWH, 66.7% were not tested using Xpert. Drop-offs were higher among PWH already on ART (Adjusted Odds Ratio [aOR] = 60.65, 95% Confidence Interval [CI]: 55.11–66.75), and those in multi-month dispensing (MMD; aOR = 1.42, 95%CI: 1.33–1.52) and differentiated models of care (DMoC; aOR = 1.10, 95%CI: 1.03–1.18) versus standard of care. Symptomatic PWH were less likely to experience Xpert drop-offs (aOR = 0.009, 95%CI: 0.008–0.011) than those without symptoms recorded. Of 1746 PWH diagnosed with TB, 6.3% did not initiate treatment, with higher drop-offs in DMoC (aOR = 29.22, 95%CI: 13.29–64.23) and MMD (aOR = 8.65, 95%CI: 2.72–27.48), but lower among symptomatic PWH (aOR = 0.05, 95%CI: 0.03–0.11). Among 1636 who started TB treatment, 25.6% did not complete it. Drop-offs were higher among those with previous TB (aOR = 2.50, 95%CI: 1.71–3.66), and lower among symptomatic PWH (aOR = 0.21, 95%CI: 0.15–0.29).
CONCLUSIONS:
Findings reveal substantial drop-offs in Xpert testing and TB treatment completion, especially among PWH already on ART. Targeted strategies to identify and retain PWH at highest risk of drop-offs are important for optimizing TUTT.
Targeted Universal Tuberculosis Testing (TUTT) is essential for early tuberculosis (TB) detection among people with HIV (PWH); however, drop-offs at key cascade stages limit its effectiveness. This study examines determinants of drop-offs at three stages: Xpert testing, TB treatment initiation, and completion.
METHODS:
We conducted a retrospective analysis of routinely collected data in fiscal year 2022 from PWH on antiretroviral therapy (ART) in rural and urban facilities in KwaZulu-Natal, South Africa. Logistic regression identified determinants of drop-offs.
RESULTS:
Among 104 859 PWH, 66.7% were not tested using Xpert. Drop-offs were higher among PWH already on ART (Adjusted Odds Ratio [aOR] = 60.65, 95% Confidence Interval [CI]: 55.11–66.75), and those in multi-month dispensing (MMD; aOR = 1.42, 95%CI: 1.33–1.52) and differentiated models of care (DMoC; aOR = 1.10, 95%CI: 1.03–1.18) versus standard of care. Symptomatic PWH were less likely to experience Xpert drop-offs (aOR = 0.009, 95%CI: 0.008–0.011) than those without symptoms recorded. Of 1746 PWH diagnosed with TB, 6.3% did not initiate treatment, with higher drop-offs in DMoC (aOR = 29.22, 95%CI: 13.29–64.23) and MMD (aOR = 8.65, 95%CI: 2.72–27.48), but lower among symptomatic PWH (aOR = 0.05, 95%CI: 0.03–0.11). Among 1636 who started TB treatment, 25.6% did not complete it. Drop-offs were higher among those with previous TB (aOR = 2.50, 95%CI: 1.71–3.66), and lower among symptomatic PWH (aOR = 0.21, 95%CI: 0.15–0.29).
CONCLUSIONS:
Findings reveal substantial drop-offs in Xpert testing and TB treatment completion, especially among PWH already on ART. Targeted strategies to identify and retain PWH at highest risk of drop-offs are important for optimizing TUTT.
| eISSN: | 2654-1459 |
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