Optimizing delivery strategies for 3HP TB preventive treatment in Tanzania: A qualitative study on acceptability of family approach in HIV care and treatment centers

Abstract

IntroductionTanzania rolled-out a 12-dose, weekly regimen of isoniazid plus rifapentine (3HP) TB preventive treatment in January, 2024. Although 3HP completion rate is generally ≥ 80%, variations exist depending on type of delivery strategy and programmatic setting. Prior to the roll-out, a mixed methods study was conducted to assess whether a family approach involving family member support, SMS reminders and three health education sessions, was acceptable and optimized 3HP uptake and completion. This paper describes acceptability of the family approach among people living with HIV (PLHIV), treatment supporters (TS) and community health workers (CHWs).MethodsThis was a qualitative descriptive study in 12 HIV care and treatment centers across six administrative regions. We purposively sampled 20 PLHIV, 12 CHWs for in-depth interviews and 23 TS for three focus group discussions held between September to December, 2023. The theoretical framework of acceptability guided thematic-content analysis using a framework approach.ResultsParticipants understood that PLHIV have high risk for active TB and that 3HP provides shortened treatment for TB disease prevention. They reported gaining TB and 3HP knowledge from health education sessions. However, participation of TS in health education sessions was low and many reported expensive transportation costs to clinics. Receiving support from someone close and SMS were perceived as good adherence reminders. The majority reported mild self-limiting side effects but expressed positive attitudes because of the shortened treatment, TB counselling, satisfaction from helping others, alignment with lifestyle and work responsibilities and reduced work burden. Some PLHIV reported difficulties in identifying family members for support thus, chose other close friends or CHWs.ConclusionsDelivery of 3HP with support from family members and SMS reminders is widely accepted by CHWs, PLHIVs and TS. Restricting support from only family members was unacceptable and attendance of all three health education sessions by TS may not be feasible.