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.
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...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2024-01-01
|
| Series: | PLOS Global Public Health |
| Online Access: | https://doi.org/10.1371/journal.pgph.0003347 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850180253980295168 |
|---|---|
| author | Allan Musinguzi Joan R Kasidi Jillian L Kadota Fred Welishe Anne Nakitende Lydia Akello Jane Nakimuli Lynn T Kunihira Bishop Opira Yeonsoo Baik Devika Patel Amanda Sammann Christopher A Berger Hélène E Aschmann Payam Nahid Robert Belknap Moses R Kamya Margaret A Handley Patrick P J Phillips Noah Kiwanuka Achilles Katamba David W Dowdy Adithya Cattamanchi Fred C Semitala Anne R Katahoire |
| author_facet | Allan Musinguzi Joan R Kasidi Jillian L Kadota Fred Welishe Anne Nakitende Lydia Akello Jane Nakimuli Lynn T Kunihira Bishop Opira Yeonsoo Baik Devika Patel Amanda Sammann Christopher A Berger Hélène E Aschmann Payam Nahid Robert Belknap Moses R Kamya Margaret A Handley Patrick P J Phillips Noah Kiwanuka Achilles Katamba David W Dowdy Adithya Cattamanchi Fred C Semitala Anne R Katahoire |
| author_sort | Allan Musinguzi |
| collection | DOAJ |
| description | 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 used thematic analysis (inductive and deductive) to align 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 needed enabled acceptance of 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, prior TPT experience with daily isoniazid, and few 3HP-related serious adverse events enabled adoption, whereas initial concerns about 3HP safety among HCPs, and COVID-19 treatment disruptions delayed 3HP adoption. Refresher training and collaboration among HCPs enabled implementation whereas limited diagnostic facilities for adverse events at the clinic hindered implementation. SAT was modified 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. Trial registration: ClinicalTrials.gov (NCT03934931); Registered 2nd May 2019; https://clinicaltrials.gov/study/NCT03934931?id = NCT03934931&rank = 1. |
| format | Article |
| id | doaj-art-41e77009facc4c0783714fa4d40e15f8 |
| institution | OA Journals |
| issn | 2767-3375 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj-art-41e77009facc4c0783714fa4d40e15f82025-08-20T02:18:15ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752024-01-01410e000334710.1371/journal.pgph.0003347Evaluating 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.Allan MusinguziJoan R KasidiJillian L KadotaFred WelisheAnne NakitendeLydia AkelloJane NakimuliLynn T KunihiraBishop OpiraYeonsoo BaikDevika PatelAmanda SammannChristopher A BergerHélène E AschmannPayam NahidRobert BelknapMoses R KamyaMargaret A HandleyPatrick P J PhillipsNoah KiwanukaAchilles KatambaDavid W DowdyAdithya CattamanchiFred C SemitalaAnne R KatahoireThree 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 used thematic analysis (inductive and deductive) to align 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 needed enabled acceptance of 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, prior TPT experience with daily isoniazid, and few 3HP-related serious adverse events enabled adoption, whereas initial concerns about 3HP safety among HCPs, and COVID-19 treatment disruptions delayed 3HP adoption. Refresher training and collaboration among HCPs enabled implementation whereas limited diagnostic facilities for adverse events at the clinic hindered implementation. SAT was modified 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. Trial registration: ClinicalTrials.gov (NCT03934931); Registered 2nd May 2019; https://clinicaltrials.gov/study/NCT03934931?id = NCT03934931&rank = 1.https://doi.org/10.1371/journal.pgph.0003347 |
| spellingShingle | Allan Musinguzi Joan R Kasidi Jillian L Kadota Fred Welishe Anne Nakitende Lydia Akello Jane Nakimuli Lynn T Kunihira Bishop Opira Yeonsoo Baik Devika Patel Amanda Sammann Christopher A Berger Hélène E Aschmann Payam Nahid Robert Belknap Moses R Kamya Margaret A Handley Patrick P J Phillips Noah Kiwanuka Achilles Katamba David W Dowdy Adithya Cattamanchi Fred C Semitala Anne R Katahoire 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. PLOS Global Public Health |
| title | 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. |
| title_full | 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. |
| title_fullStr | 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. |
| title_full_unstemmed | 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. |
| title_short | 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. |
| title_sort | 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 |
| url | https://doi.org/10.1371/journal.pgph.0003347 |
| work_keys_str_mv | AT allanmusinguzi evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT joanrkasidi evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT jillianlkadota evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT fredwelishe evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT annenakitende evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT lydiaakello evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT janenakimuli evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT lynntkunihira evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT bishopopira evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT yeonsoobaik evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT devikapatel evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT amandasammann evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT christopheraberger evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT heleneeaschmann evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT payamnahid evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT robertbelknap evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT mosesrkamya evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT margaretahandley evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT patrickpjphillips evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT noahkiwanuka evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT achilleskatamba evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT davidwdowdy evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT adithyacattamanchi evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT fredcsemitala evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial AT annerkatahoire evaluatingtheimplementationofweeklyrifapentineisoniazid3hpfortuberculosispreventionamongpeoplelivingwithhivinugandaaqualitativeevaluationofthe3hpoptionstrial |