The effect of the 3HP regimen on the completion of preventive tuberculosis treatment in people living with HIV: a retrospective cohort in Brazil

Losses in the tuberculosis (TB) preventive treatment cascade among people living with HIV/AIDS (PLHIV) are frequent, ranging from the identification of individuals at risk to treatment completion. This study aimed to analyze the factors associated with the completion of TB preventive treatment and the effect of the 3HP regimen on this outcome among PLHIV in Brazil between 2021 and 2023. A retrospective cohort study was conducted using secondary data from the Information System for the Notification of People Undergoing Treatment for Latent Mycobacterium tuberculosis Infection (IL-TB). PLHIV aged 18 years or older, regardless of CD4+ T-cell count, who were reported to IL-TB as new cases or re-exposure, were included. The outcome was the completion of TB preventive treatment. Poisson regression with robust variance was used to estimate the relative risk of treatment completion, with a 95% confidence interval. The average effect of the 3HP regimen on treatment completion was estimated using propensity score weighting. A total of 15,171 PLHIV were included, of whom 11,546 (76%) completed TB preventive treatment. Completion rates were higher among individuals aged ≥60 years, those with tuberculin skin test results ≥5 mm, and those who received the 3HP regimen. The 3HP regimen showed an average effect of increasing TB preventive treatment completion by 11%. These findings highlight the positive impact of the 3HP regimen compared to monotherapy with rifampin or isoniazid, suggesting its potential to enhance TB prevention strategies among PLHIV.

Keywords:
Latent Tuberculosis; HIV; Disease Prevention; Medication Adherence