TITLE:
Description of HIV-Infected Persons in Botswana Who Developed Active Tuberculosis during or after Isoniazid Preventive Therapy (IPT): A Retrospective Record Review
AUTHORS:
Oaitse I. Motsamai, Kebogile Mokwena, Sikhulile Moyo
KEYWORDS:
HIV, Tuberculosis, Isoniazid Preventive Therapy, Treatment Outcomes, Retrospective Record Review
JOURNAL NAME:
Journal of Tuberculosis Research,
Vol.14 No.3,
September
20,
2026
ABSTRACT: Background: Tuberculosis (TB) remains a major cause of morbidity and mortality among people living with HIV, particularly in high TB/HIV burden settings. Botswana introduced Isoniazid Preventive Therapy (IPT) for people living with Human Immunodeficiency Virus (HIV) to reduce the risk of progression from latent TB infection to active TB disease. This study describes IPT programme records and the characteristics and outcomes of HIV-infected persons who developed active TB during or after IPT exposure. Methods: A retrospective record review using IPT and TB programme registers from 24 health facilities in eight districts in Botswana. The uploaded dataset contained 1240 IPT-exposed records, classified as IPT completers, IPT defaulters, or persons who developed active TB during or after IPT exposure. Analyses were: 1) IPT programme completion/defaulting classified as completers or defaulters, and 2) TB treatment outcomes classified as g developed TB. Frequencies, proportions, means, medians, and exact 95% confidence intervals were calculated, and modified Poisson regression estimated risk ratios for common binary outcomes. Results: Of 1240 IPT-exposed records, 352 (28.4%) were IPT programme completers, 655 (52.8%) were defaulters, and 233 (18.8%) developed active TB during or after IPT exposure. Among the 1007 programme completion/defaulting records, IPT completion was 35.0% (352/1007; 95% CI 32.0 - 38.0). Male sex was associated with lower IPT completion compared with female sex (adjusted risk ratio [aRR] 0.73; 95% CI 0.61 - 0.88). Among 233 developed-TB records, 150 (64.4%) were female, median age was 37 years (IQR 32 - 43), 206 (88.4%) were new TB cases, and 162 (69.5%) had pulmonary TB. TB treatment outcomes were documented for 196/233 (84.1%) records. Among documented outcomes, 163/196 (83.2%; 95% CI 77.2 - 88.1) completed TB treatment; 17 (7.3%) died, 12 (5.2%) defaulted, 4 (1.7%) failed treatment, and 37 (15.9%) were not evaluated. In adjusted models, sex, age, Antiretroviral Therapy (ART) status, and disease classification were not strongly associated with documented TB treatment success, but incomplete records and missing ART data make this finding uncertain. Conclusions: Age showed a small link to treatment success in the sensitivity model, but incomplete records and missing ART data make this finding uncertain. IPT programme non-completion was common and was more frequent among men and younger adults. Among persons who developed TB after/during IPT exposure, most had new pulmonary TB disease, and most with documented outcomes completed TB treatment, but outcome documentation was incomplete. The findings support strengthening IPT adherence support, early follow-up of missed visits, accurate linkage of IPT, ART, and TB registers, and complete documentation of TB treatment outcomes.