Tuberculosis preventive treatment uptake among patients initiating antiretroviral therapy in Malawi: Children left behind

Background: Tuberculosis preventive treatment (TPT) is recommended for people living with HIV (PLHIV) to reduce the tuberculosis (TB) incidence in regions with a high prevalence of TB. We evaluated the uptake and completion of TPT among newly initiated antiretroviral therapy (ART) patients in a programme setting in Malawi. Objectives: To describe TPT initiation and completion rates, and explore factors associated with TPT initiation and completion among newly initiated ART patients. Method: We conducted a retrospective cohort study analysing routinely collected data from 10 ART facilities. We included all patients who initiated ART between January 2023 and March 2023, with follow-up for 12 months. We used descriptive statistics to summarise demographic and clinical characteristics, and logistic regression to assess factors associated with TPT initiation and completion. Results: A total of 1289 patients were enrolled; 1015 (78.7%) were eligible for TPT. Of these, 820 (80.8%) initiated TPT; 610 (74.4%) completed treatment. Children (< 10 years), adolescents (10–19 years), patients presenting with WHO HIV clinical stage three or four conditions, and urban residents were less likely to initiate TPT: adjusted odds ratio (aOR) 0.12 (95% confidence interval [CI] 0.06–0.22), aOR 0.30 (95% CI 0.15–0.59), aOR 0.35 (95% CI 0.21–0.60), and aOR 0.56 (95% CI 0.34–0.90), respectively. Patients who received daily isoniazid for 6 months had reduced odds of completing TPT (aOR 0.22; 95% CI 0.11–0.42) compared with weekly isoniazid plus rifapentine for 3 months. Conclusion: High TPT initiation and completion rates were observed among eligible patients initiating ART in Malawi. However, children lag in TPT initiation. Targeted interventions that improve TPT uptake among paediatric patients are required.