Engagement and retention in tuberculosis care services among people living with HIV in Lusaka, Zambia: Does gender matter?
Tuberculosis (TB) remains the leading cause of death among people living with HIV (PLHIV) worldwide. Improving the diagnosis and treatment of TB in ‘high-risk’ groups will be critical to the Global End TB strategy. It is not well appreciated that men account for two-thirds of the 9 million new adult TB cases globally. Similar to PLHIV, men represent a high-risk TB population as they are also more likely to develop TB, remain undiagnosed, and experience poor TB-related outcomes. In 2017, only 51% of all TB cases among PLHIV were diagnosed and reported and among those started on TB therapy, only 77% completed appropriate treatment. While similar global estimates are not available for men, evidence from multiple settings suggests that men present later to care and are more likely to be lost-to-follow-up. Such gaps in the TB care cascade hinders progress towards improved outcomes and control. To design novel TB interventions that aim to increase engagement and retention in TB services, an improved understanding is needed of the key barriers faced by men and women living with HIV as well as what TB service attributes they most prefer. To address these knowledge gaps, we will undertake semi-structured interviews among HIV-associated TB patients and TB providers in Lusaka, Zambia to understand key barriers to TB care engagement and how they differ between men and women. Interview results will inform the design of two discrete choice experiments among PLHIV with TB to determine what interventions that seek to improve the accessibility and acceptability of TB services are most preferred and how preferences differ between men and women. The results of this pilot will provide preliminary data for a K23 mentored career development award application to design novel, gender-tailored interventions to improve engagement and retention in TB services among PLHIV in Zambia.