Trends in prevalent TB among persons enrolling for HIV care before and after ‘Test and Treat’ across East-Africa

Abstract

Background: In 2015, WHO recommended the global adoption of the 'Test and Treat' strategy (TTS) for all persons living with HIV (PLHIV). While TTS has improved viral suppression and reduced mortality, its impact on TB in PLHIV remains unclear. Methods: We assessed TB prevalence trends 48 months before and after TTS among PLHIV aged ≥18 years enrolling at HIV primary care sites affiliated with the East Africa International Epidemiology Databases to Evaluate AIDS (EA-IeDEA) consortium. We defined prevalent TB as bacteriologically confirmed or empirically treated TB within 60 days of enrolment. We estimated monthly TB prevalence trends using Poisson (change point) model. Results: Among 125,647 PLHIV, 37% were male. The prevalence of TB was 8.9% (95% CI: 8.7-9.1) before and 6.2% (95% CI: 5.9-6.4) after TTS-adoption. Adjusted analysis showed significant downward trend in TB prevalence before TTS (adjusted Prevalence Rate Ratio, aPRR=0.989, p<0.001), which plateaued during TTS (aPRR=0.999, p=0.131). TB was more frequently present among males (aPRR: 2.09, p<0.001) and adults ≥25 years across both periods. Conclusion: This study highlights a plateau in TB prevalence decline during TTS and persistent disparities in TB by sex and age, underscoring the need for targeted interventions.