Scale-up of Tuberculosis Prevention Therapy under the Key Populations Community HIV/AIDS Action & Response (KP-CARE 1) project in Nigeria: A Community of Practice (CoP) Approach

Tuberculosis Preventive Therapy (TPT) has been implemented within HIV programmes in Nigeria since 2014 and is currently being scaled-up. Unfortunately, structural barriers hinder uptake of TPT among People Living with HIV (PLHIV). Consequently, USAID supported a CoP approach for TPT in fiscal year  2019 (FY19). Under the USAID funded KP-CARE 1 project, HALG CoP approach focused on sharing best practices, creating new knowledge, and reducing supply chain challenges for Isoniazid amongst KPs such as female sex workers, (FSW), men who have sex with men (MSM), people who inject drugs (PWID), transgender (TG), persons in correctional settings and their sexual partners in 3 states: Akwa-Ibom, Cross River, and Lagos. HALG CoP deployed a weekly tracker to routinely monitor the main indicators for TPT: eligibility, initiation, and completion. Routine programme data of KPs who accessed HIV services were analyzed from HALG’s Retention and Audit Determination Tool (RADET) between October 2019 (FY19) to September 2020 (FY20). Descriptive analysis was applied to assess the effect of CoP on TPT uptake among KPs. The mean ages in FY19 and FY20 were 44years±17years and 42years±16years respectively. Pre and post CoP intervention outcomes showed that 5,038 KPs out of 12,370 clients eligible for TPT (41%) were initiated in FY19 compared to 11,691 out of 19,890 (58%) TPT eligible clients in FY20 (p<0.0001). Increase in TPT uptake by KP typology from FY19 to FY20 was FSW (21%), PWID (26%), and TG (17%); while MSM decreased by 7%. Implementation of the CoP by HALG brought about a positive increase of 18% overall within 1 year of intervention. This evidence confirms the efficacy of the HALG CoP approach  for scale-up of TB prevention therapy among PLHIV and particularly KPs. However, more research is needed to demonstrate the effectiveness of other interventions on individual-level barriers to treatment uptake among TB clients