TB incidence following accelerated TB preventive treatment scale-up campaigns in Uganda

<sec><title>BACKGROUND</title>We evaluated the impact of the July 2019–September 2019 accelerated TB preventive therapy (TPT) initiation campaign on TB incidence among people living with HIV (PLHIV) on antiretroviral therapy (ART) in Uganda.</sec><sec><title>DESIGN</title>We conducted a quasi-experimental study using routinely collected data from patient records. The study included PLHIV aged ≥15 years who started ART from 2016 to 2023 at six public health facilities. We used inverse probability treatment weighting and a Cox proportional hazards regression model to compare TB risk before and after the accelerated TPT scale-up campaign.</sec><sec><title>RESULTS</title>Among 49,753 participants, 75% were women, with a median age of 32 years (IQR 26–39), and 9.5% were WHO clinical stage 3 or 4 at inclusion. There were 845 incident TB cases during a total follow-up of 156,191 person-years. TB risk decreased by 25% during 3.5 years following the TPT scale-up campaign compared to the period before (weighted hazard ratio wHR 0.75, 95% CI 0.59–0.94; P = 0.014). TB risk reduction was not significantly different across the sexes but varied across the clinics.</sec><sec><title>CONCLUSION</title>Accelerated TPT scale-up reduced TB incidence among PLHIV, showing that TPT is an integral and important component in decreasing TB incidence.</sec>