Systematic screening of household contacts (HHCs) of people with tuberculosis (TB) and starting them on either TB treatment or tuberculosis preventive treatment (TPT) reduces TB incidence. This project supported HHC management in six health facilities in Zimbabwe through the provision of CXR services, reimbursement of transport costs for HHCs, and provision of fuel and refreshments for healthcare workers involved in contact tracing. We describe TB and TPT cascades among the HHCs of index patients with all forms of TB. We enrolled 251 index patients who listed 794 HHCs: 551 (69%) HHCs of 158 index patients were traced and 520 (94%) screened for TB. Of the 502 who were referred to clinics, 362 (72%) reached the clinic. Among 520 HHCs, 324 (62%) underwent CXR screening and 18 (5%) had CXRs suggestive of TB. The yield of TB was 2.3% (12/520), with CXR detecting eight people who had not reported TB symptoms. Of the 311 who were assessed for TPT eligibility, 126 (41%) started TPT and 119 were assessed for TPT outcomes. Of these, 111 (93%) had successful TPT outcomes. The median times to starting TB treatment and TPT were 7 days and 11 days, respectively. The intervention facilitated timely access to healthcare services and a high yield of TB detection.

Tuberculosis preventive treatment (TPT) reduces the incidence of tuberculosis (TB) among people living with HIV (PLHIV), but its coverage remains suboptimal in most settings. We conducted a cross-sectional study to describe TPT uptake among PLHIV and factors influencing TPT initiation. Healthcare workers (HCWs) in selected facilities were trained and supported to strengthen TPT management among PLHIV, including children living with HIV (CLHIV). Of 1309 enrolled PLHIV, 1268 (97%) were eligible for TPT; 1078 (85%) initiated TPT, including 663/776 (86%) among those currently on ART and 415/492 (84%) among clients newly on ART. The major reasons for not starting TPT included stock-outs of TPT medicines, TB disease, and refusal of TPT, mostly by CLHIV and adults currently on ART. Optimal and sustained uptake of TPT can be achieved through ensuring uninterrupted stocks of TPT medicines, including shorter regimens and pediatric formulations, addressing knowledge deficits among HCWs, and improving demand for TPT by educating PLHIV and caregivers of CLHIV about the benefits and risks of TPT formulations.

People living with HIV (PLHIV) are at an increased risk of progressing from Mycobacterium tuberculosis (TB) infection to TB disease. Tuberculosis preventive treatment (TPT) is recommended for PLHIV; however, its uptake remains suboptimal. In Zimbabwe, three months of weekly rifapentine and isoniazid (3HP) and six months of daily isoniazid (6H) are the most commonly prescribed TPT regimens. We explored barriers to TPT uptake among PLHIV from the perspective of healthcare workers (HCWs) in Zimbabwe. Facility nurses who had been implementing TPT for at least six months were invited to participate in in-depth interviews and/or focus group discussions conducted in March 2023. Audio recordings were transcribed into English, coded using NVivo 12 (QSR International), and analyzed thematically. Eleven HCWs participated in in-depth interviews and 15 in focus group discussions. Barriers were categorized as person- and health system-related. Person-related barriers included misconceptions about TPT, fear of adverse events, and pill burden. Health system barriers included stock-outs of TPT medications, limited HCW knowledge and skills to promote TPT, limited expertise in initiating TPT among children under five years of age, and limited access to chest radiography. Barriers to TPT uptake and completion remain in Zimbabwe and contribute to missed opportunities for TB prevention among PLHIV. TPT implementation could be strengthened through an uninterrupted supply of TPT medications, continuous training and mentorship of HCWs, and community engagement to improve awareness of the benefits and risks of TPT.