Ending Tuberculosis through prevention: Zimbabwe’s PEPFAR Tuberculosis preventive treatment scale-up journey (2016–2024)

Background Tuberculosis (TB) is the leading cause of death among people living with HIV (PLHIV). Globally in 2023, an estimated 161,000 PLHIV died of TB. TB preventive treatment (TPT) can reduce TB mortality yet scale up remains a challenge. We documented Zimbabwe’s experience in scaling TPT among PLHIV. Methodology We analyzed routine aggregate data from the President Emergency Plan for AIDS Relief (PEPEFAR) database, Data for Accountability Transparency and Impact Monitoring (DATIM). We conducted a desk review of national guidelines, reports, training manuals, policy and strategic plans. Program reports were reviewed to understand scale up best practices, successes and challenges. Results TPT coverage (cumulative number completed TPT divided by PLHIV on ART) increased from <1% (144/950,235) in 2018 to 101% (1,040,460/1,029,583) in 2024, in PEPFAR supported health facilities. Adults had a higher TPT coverage of 102% (1,006,544/990,818) than children 87% (33,916/38,765). TPT completion (number started TPT divided number completing TPT) was significantly higher among adults, 99.2% compared to children, 97.9%, difference 1.2 percentage points (CI 0.98-1.50, p < 0.01). Key interventions resulting in improved TPT coverage and completion, included removal of the 3-months waiting period for PLHIV to initiate TPT, introduction of shorter regimens, pharmacovigilance, implementation monitoring, stakeholder engagement, and communication of updated policies. Conclusion We report a significant increase in TPT coverage and completion rates. We observed lower TPT coverage and completion among children compared to adults. TPT scale-up lessons from Zimbabwe can inform TPT expansion in countries of similar context.