Preferences, and perceived confidence and intention to complete 1HP and 3HP rifapentine-based tuberculosis preventive treatment regimens among people living with HIV at the Mulago ISS Clinic, Kampala, Uganda: a cross-sectional survey

Abstract

Background: One month of daily and three months of weekly isoniazid-rifapentine (1HP and 3HP, respectively) have similar efficacy and safety profiles and have been recommended for the prevention of tuberculosis (TB) among people living with HIV (PLHIV). As of early 2022, only 3HP had been rolled out in Uganda. It is unclear whether 1HP is acceptable and preferable to 3HP by PLHIV in Uganda.

Objectives: To determine preferences for 1HP versus 3HP and compare the levels of perceived confidence and intention to complete TB preventive treatment (TPT) using 1HP or 3HP among PLHIV in Kampala, Uganda.

Methods: This was a cross-sectional, randomized, non-intervention survey with 429 adult PLHIV enrolled in care at the Mulago ISS clinic. Participants were randomly assigned to one of two hypothetical scenarios of receiving either 1HP or 3HP and asked to rate their level of perceived confidence and intention to complete treatment using an 11-point Likert scale (0-10). Participants were also asked to state their preference between 1HP and 3HP. Logistic regression was used to explore variation within confidence-intention scores and participants’ preference for 1HP versus 3HP with sociodemographic and clinical characteristics respectively.

Results: Of the 429 respondents, 206 (48.0%) were randomly assigned to hypothetical 1HP and 223 (52.0%) were assigned to hypothetical 3HP between September and November 2022. The median age was 43 years (interquartile range, IQR: 38-50 years) and 71.1% were female. All were receiving antiretroviral therapy. Participants expressed high confidence and intention to complete both 1HP and 3HP. Overall, 81 (18.9%) preferred 1HP and 348 (81.1%) preferred 3HP. Confidence-intention scores differed by education status and by use of hormonal contraception. Preference for 1HP was greater among those without a history of prior TB disease and those randomly assigned to hypothetical 1HP.

Conclusions and recommendations: Both 1HP and 3HP were highly acceptable among PLHIV for TB prevention. When given a choice, most PLHIV preferred 3HP; however about 19% preferred 1HP. Therefore, to provide patient-centered care and when available, an option to choose between regimens should be provided to PLHIV within the HIV programme.