Predictors of tuberculosis preventive therapy initiation among people living with HIV in the Volta region, Ghana

Abstract Background Tuberculosis (TB) remains a leading cause of morbidity and mortality among people living with HIV (PLHIV) despite the availability of effective preventive interventions. Tuberculosis Preventive Therapy (TPT), strongly recommended by the World Health Organization, substantially reduces the risk of active TB among PLHIV, however, uptake of TPT remains suboptimal in many settings. This study, therefore, assessed the predictors of TPT initiation, beginning the course of anti-TB medications among PLHIV. Methods This was a health facility-based analytical cross-sectional study among 806 PLHIV aged ≥ 18 years attending antiretroviral therapy (ART) clinics in the Volta Region of Ghana. A systematic sampling technique was employed to recruit respondents, and data were collected using structured questionnaires mounted in the Kobo Toolbox. Data was exported to Stata version 17.0 for analysis. Descriptive and logistic regression analyses were performed, with statistical significance set at a p < 0.05 at 95% confidence interval. Results Our study found that out of the 806 PLHIV recruited, with a mean age of 44.7 years (SD ± 13), the majority, 481 (59.70%), were found to have poor knowledge of TPT. We found that 620/806 (88.6%) PLHIV were eligible for TPT, and among those eligible, only 236 (38.1%) were initiated on TPT. Respondents who had good knowledge of TPT were about 7 times more likely to be initiated compared with those who had poor knowledge (aOR = 6.79, 95% CI 4.69–9.83, p < 0.001). Those who had been diagnosed with HIV for one year or more were 4 times as likely to be initiated as those diagnosed for less than a year (aOR = 4.18, 95% CI 1.74–10.04, p = 0.001). Respondents in HIV clinical stage 2 were 66% less likely to be initiated than those in stage 1 (aOR = 0.34, 95% CI 0.20–0.58, p < 0.001). With respect to marital status, married respondents were 40% less likely to be initiated on TPT compared with single respondents (aOR = 0.60, 95% CI 0.37–0.97, p = 0.038). Barriers perceived by PLHIV to TPT initiation were distance to facility, poor health education, and limited drug availability. Conclusion TPT initiation among PLHIV in the Volta Region was suboptimal, and key predictors of initiation were TPT knowledge, duration since HIV diagnosis, HIV clinical stage, and marital status. Strengthening patient education, ensuring consistent drug and logistics availability, and addressing implementation barriers are critical to improving uptake and advancing progress toward Sustainable Development Goal 3.3 targets.