Resumo

MOTLHAOLENG, Katlego et al. Determinants of drop-offs in the targeted universal tuberculosis testing care cascade among people with HIV in rural and urban facilities in South Africa. South. Afr. j. HIV med. (Online) [online]. 2026, vol.27, n.1, pp.1-9. ISSN 2078-6751.  https://doi.org/10.4102/sajhivmed.v27i1.1774.

BACKGROUND: Targeted Universal Tuberculosis Testing (TUTT) is a strategy for early tuberculosis (TB) detection among people with HIV (PWH); however, drop-offs at key cascade stages limit its effectiveness OBJECTIVES: This study examines determinants of drop-offs at three stages: rapid molecular diagnostic test for TB (Xpert) TB treatment initiation, and completion METHOD: 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 CONCLUSION: 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 optimising TUTT

Palavras-chave : TB screening; targeted universal TB Testing; drop-offs; TB care cascade; people with HIV; TB/HIV integration; differentiated service delivery.

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