Implementation of tuberculosis care cascade among adult people living with HIV registered in anti-retroviral therapy centres in Odisha, India, 2020-2023.

BACKGROUND

India bears a significant burden of HIV-tuberculosis co-infections reporting 48,000 cases in 2022. Although a comprehensive national framework exists for managing tuberculosis and tuberculosis preventive treatment among People Living with HIV (PLHIV), implementation gaps persist. We conducted this study to describe the tuberculosis care cascade among newly registered adult PLHIV attending anti-retroviral therapy (ART) centres in Odisha, India.

METHODS

We conducted a secondary analysis of programme data from all the 19 anti-retroviral therapy centres across Odisha’s 30 districts. The study included adult PLHIV and newly registered at anti – retroviral therapy centres from April 2020 to March 2023, excluding those with pre-existing tuberculosis during registration, non-residents of Odisha and transferred-out cases. The follow up data was available till March 2024. Data were extracted from two digital platforms i.e., the SOCH (for baseline characteristics, symptomatic screening of tuberculosis − 4s screening, and tuberculosis preventive treatmentr) and Ni-kshay (for type and treatment outcome of tuberculosis) portal which are digital platforms for HIV/AIDS and tuberculosis program in the country. Extracted data was cleaned, coded and analysed.

RESULTS

A total of 4,835 newly registered PLHIV were included out of which data related to 4s screening for tuberculosis was available for only 19.3% (n = 934) individuals. Among 934 for whom the data was available, 4s  screening was done among 94.3% (95% CI: 92.6% − 95.7%) i.e. 881 individuals. Among those who were screened for 4s  symptoms (n = 881), the positivity for any of 4s symptoms was 18.4% (95% CI: 15.9% − 21.1%). Among those who were eligible for tuberculosis preventive treatment (n = 668), initiation was done among 64.2% (95% CI: 60.5%-67.9%). Overall, 65 PLHIV were diagnosed with tuberculosis from the date of ART registration and till March 2024. Out of which treatment outcome data was available for 61 individuals. Successful treatment outcome was seen in 78.7% adult PLHIV.

CONCLUSION

After registration at ART centre, symptomatic screening was done for majority of PLHIV but initiation of tuberculosis preventive treatment was less. Data inconsistencies and sub-optimal data entry in the management information system highlights the need for further research for strengthening the system.