BACKGROUND: In 2018, the President’s Emergency Plan for AIDS Relief (PEPFAR) committed to providing tuberculosis preventive treatment (TPT) to all people living with HIV (PLWH) receiving antiretroviral therapy (ART) through PEPFAR-supported programs. During US government fiscal years (FY) 2017–2022, PEPFAR set cumulative targets for 22,275,651 PLWH to complete TPT. We assessed target achievement, TPT completion rates, and remaining gaps in 54 countries where PEPFAR operated in 2022.
METHODS: PEPFAR Monitoring, Evaluation, and Reporting (MER) data for FY 2017–2022 were used to report the number of PLWH who started and completed TPT. Target achievement was defined as cumulative number of TPT completions divided by cumulative TPT targets. TPT completion rates were calculated by dividing the number of TPT completions by initiations, and differences in age, sex, and whether ART had been initiated recently were examined. To estimate the number of PLWH who may remain eligible for TPT, cumulative TPT completions were subtracted from the number of PLWH currently on ART in PEPFAR-supported programs.
RESULTS: Overall, 11,307,593 TPT completions were reported, representing 51% target achievement. The overall TPT completion rate was 78%. No major differences were noted by age or sex. TPT completion among those initiating TPT within six months of ART initiation was 72%, versus 83% among those on ART for longer than six months when TPT was initiated. By FY22, PEPFAR was providing ART to 19,238,096 PLWH, suggesting that up to 7,930,503 (41%) PLWH currently in PEPFAR-supported programs may remain eligible for TPT (Figure 1).
CONCLUSIONS: Though progress has been made in providing lifesaving TPT to PLWH, gaps remain across PEPFAR. Improved active TB case finding, surge and sustain campaigns, shorter TPT regimens, and enhanced reporting and recording systems may expand TPT coverage. Lower TPT completion rates among clients new to ART warrant interventions to improve adherence.

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