Improving Detection and Prevention of Tuberculosis among Children Living with HIV through the integration of TB care within HIV care and treatment services in Uganda – (Pre and Post-implementation assessment of the CaP-TB project)

Improving Detection and Prevention of Tuberculosis among Children Living with HIV through the integration of TB care within HIV care and treatment services in Uganda – (Pre and Post-implementation assessment of the CaP-TB project) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Improving Detection and Prevention of Tuberculosis among Children Living with HIV through the integration of TB care within HIV care and treatment services in Uganda – (Pre and Post-implementation assessment of the CaP-TB project) Richard Fredrick Okello, Henry Ijjo, Patrick Kazooba, Dickens Odongo, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7017309/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Systematic integration of tuberculosis (TB) screening among children living with HIV (CLHIV) remains a crucial intervention for active TB case finding and prevention among children. Methods: The Catalyzing Pediatric TB Innovation Project (CaP-TB) implemented decentralized and integrated models of care during a 27-month period (July 2019 – September 2021) to improve the detection of active and latent TB among children aged 0-14 years living with HIV and receiving care. The project targeted 20 high TB burden HIV health facilities (primary 35%, Secondary 45% and tertiary 20%) of Southwestern Uganda. The study collected data before and during the project implementation period and conducted a pre and post quasi-experimental evaluation on outcomes change from pre- to post-intervention. Results: During the CaP-TB implementation period, 7,251 CLHIV (49.1% Male, 50.9% female; 0-<2yrs-0.5%, 2-<5yrs-6.7%, 5-<10yrs-27.5% and 10-<15yrs-65.3%) were screened for TB signs and symptoms at 20 HIV clinics. Significant improvements from pre- to post-intervention were noted in the following outcomes: Screening-percentage of CLHIV screened for TB per site increased from 3.6% to 38.1% (IRR: 9.7; p<0.001; 95% CI: 8.5-11.0). For children aged 0–<5 years, TB screening coverage increased more than five-fold (IRR: 5.2, 95% CI: 3.9–7.0), while among those aged 5–<15 years, it improved over ten-fold (IRR: 11.7, 95% CI: 10.2–13.6). In rural facilities, TB screening coverage increased nearly eight-fold (IRR: 7.9, 95% CI: 6.2–10.1), while in urban facilities, it improved more than eleven-fold (IRR: 11.6, 95% CI: 9.9–13.5). Presumption- percentage of presumptive TB positive cases per site increased from 3.0% to 5.8% (IRR: 1.7; p<0.001; 95% CI: 1.5-2.0), Among children aged 5–<15-year-olds, the percentage of presumptive TB positive cases per site more than doubled (IRR: 2.1, 95% CI: 1.8–2.4). In rural sites, the percentage of presumptive TB positive cases per site increased by 1.5 times sites (IRR: 1.5, 95% CI: 1.2–2.0) and doubled in urban sites (IRR: 2.0, 95% CI: 1.7–2.4). TB detection- Active TB case detection rate per site increased from 0.4% to 0.9% (IRR: 2.0; p<0.001; 95% CI: 1.4, 3.1). Among children aged 0–<5-year-olds, active TB case detection rate per site increased 1.4-fold (IRR: 1.4, 95% CI: 0.8–2.6) and a more than three-fold increase among 5–<15-year-olds (IRR: 3.3, 95% CI: 1.9–5.8). In rural facilities, active TB case detection rate per site increased 1.4-fold increase (IRR: 1.4, 95% CI: 0.7–3.1), while in urban facilities, it more than doubled (IRR: 2.5, 95% CI: 1.5–4.0). TPT initiation- percentage of new TPT initiations per site increased from 0.7% to 92.6% (IRR: 131; p<0.001, 95% CI: 95.8-177.8). Conclusion: Systematic integration of childhood TB screening in decentralized pediatric HIV clinics at multiple health facility levels significantly improves rates of active TB diagnosis and prevention therapy uptake among CLHIV in Uganda. Program implementers and managers therefore must prioritize systematic TB screening which offers opportunities to significantly enhance TB diagnosis, treatment, and prevention success among children 0 -14 years old. Integration TB case detection TPT prevention HIV care and treatment services Uganda Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7017309","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":591279979,"identity":"4fd6f012-3a69-4802-8f81-ed8a111461a2","order_by":0,"name":"Richard Fredrick Okello","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYBACPiD+wMDAzMDGwMb4AMjh4SOkhY2BgXEGVAuzAUgLG9FagEw2CagIAS3svQ+bKyqs8/nYj6VVfs2xk2FjYH746AY+LTzHDRvPnEm3bONJO3Zbdlsy0GFsxsY5+LRIpLE/bGw7bMAmwd52W3IbM1ALD5s0AS2MjY3/IFqKJbfVE6ulAaSF7Rjjx22HidDCc4yxseFYugEbT1qyNOO24zxszAT8ws/eBtRSY20g337M8OPPbdX2/OzNDx/j04ICmHnAJLHKQYDxBymqR8EoGAWjYMQAALFiO89o3Ks5AAAAAElFTkSuQmCC","orcid":"","institution":"Elizabeth Glaser Pediatric AIDS Foundation, Uganda","correspondingAuthor":true,"prefix":"","firstName":"Richard","middleName":"Fredrick","lastName":"Okello","suffix":""},{"id":591279980,"identity":"6f1b712b-af6e-4992-ab0f-f17bc27c08e8","order_by":1,"name":"Henry Ijjo","email":"","orcid":"","institution":"Elizabeth Glaser Pediatric AIDS Foundation, Uganda","correspondingAuthor":false,"prefix":"","firstName":"Henry","middleName":"","lastName":"Ijjo","suffix":""},{"id":591279981,"identity":"9adc42e0-6882-462f-b12b-f67323e1db55","order_by":2,"name":"Patrick Kazooba","email":"","orcid":"","institution":"Elizabeth Glaser Pediatric AIDS Foundation, Uganda","correspondingAuthor":false,"prefix":"","firstName":"Patrick","middleName":"","lastName":"Kazooba","suffix":""},{"id":591279982,"identity":"7c214fc3-ce41-40b3-b5d2-3bce24163a24","order_by":3,"name":"Dickens Odongo","email":"","orcid":"","institution":"Elizabeth Glaser Pediatric AIDS Foundation, Uganda","correspondingAuthor":false,"prefix":"","firstName":"Dickens","middleName":"","lastName":"Odongo","suffix":""},{"id":591279983,"identity":"0416af6e-a530-4ba7-8839-e1a12b6a67ff","order_by":4,"name":"Rachael Tumwebaze","email":"","orcid":"","institution":"Elizabeth Glaser Pediatric AIDS Foundation, Uganda","correspondingAuthor":false,"prefix":"","firstName":"Rachael","middleName":"","lastName":"Tumwebaze","suffix":""},{"id":591279984,"identity":"3bdd9192-ae84-43b9-a02c-95fbc6ee249a","order_by":5,"name":"Eliab K. Natumanya","email":"","orcid":"","institution":"Elizabeth Glaser Pediatric AIDS Foundation, Uganda","correspondingAuthor":false,"prefix":"","firstName":"Eliab","middleName":"K.","lastName":"Natumanya","suffix":""},{"id":591279985,"identity":"6decb760-7368-4f54-aff5-d71c32b6c4d8","order_by":6,"name":"Edward Bitarakwate","email":"","orcid":"","institution":"Elizabeth Glaser Pediatric AIDS Foundation, Uganda","correspondingAuthor":false,"prefix":"","firstName":"Edward","middleName":"","lastName":"Bitarakwate","suffix":""},{"id":591279986,"identity":"520b4919-105a-48d9-b822-d07fa4b5f033","order_by":7,"name":"Mary Namubiru","email":"","orcid":"","institution":"Elizabeth Glaser Pediatric AIDS Foundation, Uganda","correspondingAuthor":false,"prefix":"","firstName":"Mary","middleName":"","lastName":"Namubiru","suffix":""},{"id":591279987,"identity":"e2b978ae-301c-4eb3-800b-c548f3ffb698","order_by":8,"name":"Nicholas Hellmann","email":"","orcid":"","institution":"Elizabeth Glaser Pediatric AIDS Foundation","correspondingAuthor":false,"prefix":"","firstName":"Nicholas","middleName":"","lastName":"Hellmann","suffix":""},{"id":591279988,"identity":"80f5e014-cb8c-4f65-ab0b-dd5cd8e9cdc9","order_by":9,"name":"Martina Casenghi","email":"","orcid":"","institution":"Elizabeth Glaser Pediatric AIDS Foundation","correspondingAuthor":false,"prefix":"","firstName":"Martina","middleName":"","lastName":"Casenghi","suffix":""},{"id":591279989,"identity":"6d1ddecd-8a95-428a-9dc3-a6a3a3610f05","order_by":10,"name":"Laura Guay","email":"","orcid":"","institution":"Elizabeth Glaser Pediatric AIDS Foundation","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"","lastName":"Guay","suffix":""}],"badges":[],"createdAt":"2025-07-01 07:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7017309/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7017309/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eImproving Detection and Prevention of Tuberculosis among Children Living with HIV through the integration of TB care within HIV care and treatment services in Uganda – (Pre and Post-implementation assessment of the CaP-TB project)\u003c/strong\u003e\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Integration, TB case detection, TPT prevention, HIV care and treatment services, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-7017309/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7017309/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Systematic integration of tuberculosis (TB) screening among children living with HIV (CLHIV) remains a crucial intervention for active TB case finding and prevention among children.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The Catalyzing Pediatric TB Innovation Project (CaP-TB) implemented decentralized and integrated models of care during a 27-month period (July 2019 – September 2021) to improve the detection of active and latent TB among children aged 0-14 years living with HIV and receiving care. The project targeted 20 high TB burden HIV health facilities (primary 35%, Secondary 45% and tertiary 20%) of Southwestern Uganda. The study collected data before and during the project implementation period and conducted a pre and post quasi-experimental evaluation on outcomes change from pre- to post-intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u0026nbsp;\u003c/strong\u003eDuring the CaP-TB implementation period,\u003cstrong\u003e \u003c/strong\u003e7,251 CLHIV (49.1% Male, 50.9% female; 0-\u0026lt;2yrs-0.5%, 2-\u0026lt;5yrs-6.7%, 5-\u0026lt;10yrs-27.5% and 10-\u0026lt;15yrs-65.3%) were screened for TB signs and symptoms at 20 HIV clinics. Significant improvements from pre- to post-intervention were noted in the following outcomes: Screening-percentage of CLHIV screened for TB per site increased from 3.6% to 38.1% (IRR: 9.7; p\u0026lt;0.001; 95% CI: 8.5-11.0). For children aged 0–\u0026lt;5 years, TB screening coverage increased more than five-fold (IRR: 5.2, 95% CI: 3.9–7.0), while among those aged 5–\u0026lt;15 years, it improved over ten-fold (IRR: 11.7, 95% CI: 10.2–13.6). In rural facilities, TB screening coverage increased nearly eight-fold (IRR: 7.9, 95% CI: 6.2–10.1), while in urban facilities, it improved more than eleven-fold (IRR: 11.6, 95% CI: 9.9–13.5). Presumption- percentage of presumptive TB positive cases per site increased from 3.0% to 5.8% (IRR: 1.7; p\u0026lt;0.001; 95% CI: 1.5-2.0), Among children aged 5–\u0026lt;15-year-olds, the percentage of presumptive TB positive cases per site more than doubled (IRR: 2.1, 95% CI: 1.8–2.4). In rural sites, the percentage of presumptive TB positive cases per site increased by 1.5 times sites (IRR: 1.5, 95% CI: 1.2–2.0) and doubled in urban sites (IRR: 2.0, 95% CI: 1.7–2.4). TB detection- Active TB case detection rate per site increased from 0.4% to 0.9% (IRR: 2.0; p\u0026lt;0.001; 95% CI: 1.4, 3.1). Among children aged 0–\u0026lt;5-year-olds, active TB case detection rate per site increased 1.4-fold (IRR: 1.4, 95% CI: 0.8–2.6) and a more than three-fold increase among 5–\u0026lt;15-year-olds (IRR: 3.3, 95% CI: 1.9–5.8). In rural facilities, active TB case detection rate per site increased 1.4-fold increase (IRR: 1.4, 95% CI: 0.7–3.1), while in urban facilities, it more than doubled (IRR: 2.5, 95% CI: 1.5–4.0). TPT initiation- percentage of new TPT initiations per site increased from 0.7% to 92.6% (IRR: 131; p\u0026lt;0.001, 95% CI: 95.8-177.8).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSystematic integration of childhood TB screening in decentralized pediatric HIV clinics at multiple health facility levels significantly improves rates of active TB diagnosis and prevention therapy uptake among CLHIV in Uganda. Program implementers and managers therefore must prioritize systematic TB screening which offers opportunities to significantly enhance TB diagnosis, treatment, and prevention success among children 0 -14 years old.\u003c/p\u003e","manuscriptTitle":"Improving Detection and Prevention of Tuberculosis among Children Living with HIV through the integration of TB care within HIV care and treatment services in Uganda – (Pre and Post-implementation assessment of the CaP-TB project)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-17 10:56:02","doi":"10.21203/rs.3.rs-7017309/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dbe1d58b-97d2-4ac1-a799-def511218288","owner":[],"postedDate":"February 17th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-17T10:56:02+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-17 10:56:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7017309","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7017309","identity":"rs-7017309","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}