# Analysis of Tuberculosis Preventive Treatment Cascade Among People With Human Immunodeficiency Virus in Georgia: A Mixed-Methods Study

## TL;DR

This study finds low uptake and adherence to tuberculosis preventive treatment among people with HIV in Georgia, pointing to coordination, data, and training issues that need fixing.

## Contribution

The study introduces a mixed-methods analysis of TPT implementation in Georgia, identifying specific barriers and proposing integration into HIV care and electronic systems.

## Key findings

- Only 11.8% of people with HIV in Georgia initiated TPT, with low adherence and completion rates.
- Active TB incidence was 10/1000 person-years among those not receiving TPT.
- Barriers include poor service coordination, data limitations, and lack of training.

## Abstract

Tuberculosis preventive treatment (TPT) is crucial for reducing tuberculosis (TB) incidence and related mortality among people with human immunodeficiency virus (HIV); however, its implementation in Georgia faces challenges. In this study, we aimed to explore the TPT care cascade among people with HIV (PWH) in Georgia.

Using a mixed-methods approach, we assessed TPT uptake, adherence, and impact on TB development within the 2019–2020 cohort of newly diagnosed PWH across 4 major HIV service providers in Georgia. With qualitative analysis under the Consolidated Framework for Implementation Research, we identified barriers and facilitators to its implementation.

Among 1165 PWH, only 11.8% initiated TPT with isoniazid. Thirty-two developed active TB (incidence rate, 10/1000 person-years [95% confidence interval, 9.6–10.4]), none of whom received TPT. Only 43% of 137 PWH on TPT adhered for 3–6 months; 29 (21.1%) completed the full course. The study revealed poor TPT service coordination, worsened by major data limitations. Interviews identified several barriers to effective TPT implementation, summarized into 3 broad categories: the need for TPT service integration into HIV care, the potential development of an integrated electronic data system, and training gaps.

Our study revealed low TPT coverage among Georgian PWH and significant data gaps. Findings underscore the need to reevaluate the TPT care cascade, emphasizing improved record-keeping and reporting practices through an integrated electronic system. Enhancing access by integrating TPT into HIV care, reducing stigma through streamlined referrals, and strengthening healthcare worker training are critical to increasing TPT uptake and ultimately reducing TB morbidity and mortality among PWH in Georgia.

Low tuberculosis preventive treatment (TPT) uptake and poor adherence among people with HIV in Georgia highlight critical gaps in service coordination, data systems, and training. Integration of TPT into HIV care and electronic record improvements are key to reducing tuberculosis burden.