Background: Providing tuberculosis (TB) preventive treatment (TPT) is essential to prevent TB among people living with HIV (PLHIV). Despite the wide availability of TPT (six-month isoniazid regimen) in Cameroon, uptake was suboptimal, varying between 31% and 37% among newly-identified PLHIV in 2022 in Cameroon’s South region. We report the experience of a collaborative quality improvement (CQI) project aiming to increase TPT uptake in the South region which has the highest HIV prevalence in the country.
Description: Between June 2022 and May 2023, a collaborative CQI was implemented in 21 health facilities. Brainstorming sessions were held to identify root causes of low TPT uptake. Identified gaps included limited frontline staff knowledge, poor documentation, and weak systems for identifying eligible clients not initiated on TPT. The intervention package included refresher training of front-line staff, line listing and bookmarking eligible clients’ charts, systematic education and prescription of TPT during client visits, and routine review of pharmacy data to catch missed initiation of TPT among eligible clients. To assess the effect of the CQI project on improving TPT uptake, we compared the trend in TPT initiation in PLHIV already on ART (> 12 months at CQI implementation) and newly initiated on ART (≤ 12 months at CQI implementation) before and after CQI implementation, respectively, using an interrupted time series regression with Newey-West standard errors.
Lessons Learned: CQI implementation was associated with a significant positive change in the 12-month post-intervention trend of TPT uptake among PLHIV already on ART (+1.17 percentage points per month, p < 0.001), and among PLHIV newly initiated on ART (+3.30 percentage points per month, p < 0.001), indicating accelerated improvement in uptake over time following implementation.
Next Steps: These findings suggest that structured CQI approaches can strengthen TPT uptake and support achievement of national and global tuberculosis prevention targets.