
==== Front
medRxiv
MEDRXIV
medRxiv
Cold Spring Harbor Laboratory

10.1101/2024.08.19.24308041
preprint
1
Article
Evaluating the implementation of weekly rifapentine-isoniazid (3HP) for tuberculosis prevention among people living with HIV in Uganda: A qualitative evaluation of the 3HP Options Trial.
Musinguzi Allan http://orcid.org/0000-0001-9941-6433

Kasidi Joan R. http://orcid.org/0000-0002-4761-462X

Kadota Jillian L. http://orcid.org/0000-0003-4568-8681

Welishe Fred
Nakitende Anne
Akello Lydia
Nakimuli Jane
Kunihira Lynn T.
Opira Bishop
Baik Yeonsoo http://orcid.org/0000-0001-7016-0438

Patel Devika http://orcid.org/0000-0002-1479-3588

Sammann Amanda http://orcid.org/0000-0002-8044-7165

Berger Christopher A.
Aschmann Hélène E. http://orcid.org/0000-0003-1234-4321

Nahid Payam http://orcid.org/0000-0003-2811-1311

Belknap Robert
Kamya Moses R. http://orcid.org/0000-0001-9106-4234

Handley Margaret A. http://orcid.org/0000-0001-5034-2111

Phillips Patrick PJ http://orcid.org/0000-0002-6336-7024

Kiwanuka Noah http://orcid.org/0000-0003-2471-9290

Katamba Achilles
Dowdy David W.
Cattamanchi Adithya http://orcid.org/0000-0002-6553-2601

Semitala Fred C. http://orcid.org/0000-0002-0624-7640

Katahoire Anne R. http://orcid.org/0000-0003-3520-070X

22 8 2024
2024.08.19.24308041https://creativecommons.org/licenses/by/4.0/ This work is licensed under a Creative Commons Attribution 4.0 International License, which allows reusers to distribute, remix, adapt, and build upon the material in any medium or format, so long as attribution is given to the creator. The license allows for commercial use.
http://medrxiv.org/lookup/doi/10.1101/2024.08.19.24308041
nihpp-2024.08.19.24308041.pdf
Three months of isoniazid-rifapentine (3HP) is being scaled up for tuberculosis (TB) preventive treatment (TPT) among people living with HIV (PLHIV) in high-burden settings. More evidence is needed to identify factors influencing successful 3HP delivery. We conducted a qualitative assessment of 3HP delivery nested within the 3HP Options Trial, which compared three optimized strategies for delivering 3HP: facilitated directly observed therapy (DOT), facilitated self-administered therapy (SAT), and patient choice between facilitated DOT and facilitated SAT at the Mulago HIV/AIDS clinic in Kampala, Uganda. We conducted 72 in-depth interviews among PLHIV purposively selected to investigate factors influencing 3HP acceptance and completion. We conducted ten key informant interviews with healthcare providers (HCPs) involved in 3HP delivery to identify facilitators and barriers at the clinic level. We used post-trial 3HP delivery data to assess sustainability. We conducted an inductive thematic analysis and aligned the emergent themes with the RE-AIM framework dimensions to report implementation outcomes. Understanding the need for TPT, once-weekly dosing, shorter duration, and perceived 3HP safety enhanced acceptance overall. Treatment monitoring by HCPs and reduced risk of HIV status disclosure enabled DOT acceptance. Dosing autonomy enabled SAT acceptance. Switching between DOT and SAT as required enabled acceptance for patient choice. Dosing reminders, reimbursement for clinical visits, and social support enabled 3HP completion; pill burden, side effects, and COVID-19-related treatment restrictions hindered completion. All HCPs were trained and participated in 3HP delivery with high fidelity. Training, care integration, and collaboration among HCPs enabled, whereas initial concerns about 3HP safety among HCPs delayed 3HP adoption and implementation. SAT was maintained post-trial; DOT was discontinued due to inadequate ongoing financial support beyond the study period. Facilitated delivery strategies made 3HP treatment convenient for PLHIV and were feasible and implemented with high fidelity by HCPs. However, the costs of 3HP facilitation may limit wider scale-up.
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pmc
