ArticleSouthern African journal of HIV medicine2026
Determinants of drop-offs in the targeted universal tuberculosis testing care cascade among people with HIV in rural and urban facilities in South Africa.
Article in Southern African journal of HIV medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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.
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