Project Summary

Tuberculosis (TB) remains a leading cause of illness and death among people living with HIV (PLHIV), even when they are receiving antiretroviral therapy (ART). TB preventive therapy (TPT) reduces the risk of developing active TB, but some PLHIV still develop TB after completing TPT, and little is known about when this occurs or which patients are most at risk, especially in high-burden African settings.

In this study, we examined over 2,900 PLHIV who completed TPT at a high-volume referral hospital in southwestern Uganda. We found that TB incidence after TPT was very low only 0.44% over nearly 106,000 person-months of follow-up with no cases in the first year, demonstrating strong early protection. However, TB risk increased with longer follow-up, particularly among younger adults under 40 years. We also found that PLHIV with unsuppressed viral loads were much more likely to develop TB, highlighting the importance of maintaining effective HIV treatment.

Our findings suggest that while TPT is highly effective in the short term, ongoing monitoring, viral load control, and targeted support for higher-risk groups such as younger adults and those on second-line ART regimens are critical to sustaining TB prevention. These results can inform TB/HIV care programs in Uganda and similar high-burden settings, emphasizing integrated approaches that combine preventive therapy, long-term follow-up, adherence support, risk-stratification with possibility of repeat TPT and nutritional assessment to reduce TB burden among PLHIV.

 

Funder: Self-funded

Current status: Manuscript writing and Dissemination

Principal Investigator: Dr Richard Tuwayenga,

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Senior Investigator/Mentor: Dr Atwine Daniel