Preferences and perceptions around uptake of different TB preventive therapy regimens: An exploratory study in Gauteng and Limpopo, South Africa

Abstract

TB preventive therapy (TPT) is one of three key interventions for reducing TB in South Africa, but uptake and completion rates remain low. In South Africa, the current TPT options include isoniazid and rifapentine or isoniazid and rifampicin. Evidence and lessons learned from programmatic uses of isoniazid preventative therapy (IPT) could provide operational advice to enhance the implementation of new TPT regimens. We conducted 28 in-depth provider interviews (IDIs) to elicit experiences of and preferences for the different TPT regimens between 04/2022 and 12/2022 in the City of Johannesburg, Gauteng and Greater Tzaneen sub-district, Mopani district, Limpopo Provinces. We used purposive sampling to recruit doctors (n=7), pharmacists (n=8) and nurses (n=13) in high and low volume TB and/or HIV facilities. IDIs were recorded for quality, transcription, and translation purposes. Data analysis was conducted using a thematic approach in NVivo 11. We present provider preferences and perspectives for TPT uptake. The most important attributes relating to preferences for TPT regimens attributes among healthcare providers included medication safety, efficacy and low pill burden. Despite valid preferences for different regimens, healthcare service providers had varied experiences around factors that influence the uptake of the different TPT regimens they offered at their facilities. Many providers indicated that patient booking errors, missing patient records, staff shortages, long queues, medication side effects and limited understanding of the benefits of TPT were reasons for poor patient TPT uptake and adherence. Limited knowledge was attributed to a lack of educational materials and insufficient staff-patient engagement time. Providers noted that increased clinician awareness and patient counselling contribute to a higher rate of TPT prescriptions, as well as improved patient uptake and adherence. Thus counselling, staff training, side-effects management, and improved file documentation are key factors for TPT uptake.