Toward patient-centered tuberculosis preventive treatment: preferences for regimens and formulations in Lima, Peru

Abstract

Background: To ensure patient-centered TB preventive treatment, it is important to consider factors that make it easier for patients to complete treatment. However, there is little published literature about patient preferences for different preventive treatment regimen options, particularly from countries with high tuberculosis burdens. Methods: We conducted a qualitative research study using a framework analysis approach to understand preventive treatment preferences among household contacts. We conducted three focus group discussions with 16 members of families affected by TB in Lima, Peru. Participants were asked to vote for preferred preventive treatment regimens and discuss the reasons behind their choices. Coding followed a deductive approach based on prior research, with data-driven codes added. Results: In total, 7 (44%) participants voted for 3 months isoniazid and rifapentine, 4 (25%) chose 3 months isoniazid and rifampicin, 3 (19%) chose 4 months rifampicin, and 2 (13%) chose 6 months isoniazid. Preferences for shorter regimens over 6 months of isoniazid were driven by concerns over "getting tired" or "getting bored" of taking medications, the difficulty of remembering to take medications, side effects, and interference with daily life. For some, weekly dosing was perceived as being easier to remember and less disruptive, leading to a preference for 3 months isoniazid and rifapentine, which is dosed weekly. However, among caregivers, having a child-friendly formulation was more important than regimen duration. Caregivers reported difficulty in administering pills to children, and preferred treatments available as syrup or dispersible formulations. Conclusions: There is demand for shorter regimens and child-friendly formulations for preventive treatment in a high-burden setting. Individual preferences differ, suggesting that patient-centered care would best be supported by having multiple shorter regimens available.

Implementation of isoniazid preventive therapy in southern Lima, Peru: an analysis of health center characteristics

“…Other studies have found this to be true, specifically in the context of TB treatment [ 28 , 29 ]. The higher treatment completion among older contacts may be due to the difficulty of administering pills to young children [ 30 , 31 ], as pediatric formulations of isoniazid are not available in Peru. Greater autonomy of adolescent contacts and less reliance on caregivers may have also contributed to this result.…”

What's new in childhood tuberculosis

“…Study participants in Peru preferred the 3-month weekly rifapentine plus isoniazid (3HP) regimen as it was easier to remember and less disruptive of everyday life. However, caregivers favoured a child-friendly regimen of syrups or dispersible tablets above the shorter treatment duration, which highlights the need to prioritize access to a child-friendly formulation of rifapentine [17 ▪ ]. Ongoing and upcoming studies investigating the use of 3HP in children, which importantly include those less than 2 years [TB Clinical Trials Consortium Study (TBTC) 35] [18] and 1-month daily rifapentine and isoniazid in children (IMPAACT 2024) [19] will provide additional evidence on the dosing, safety and acceptability of these regimens and inform options available to young household contacts.…”