Perceived benefits of community-based TB preventive treatment in children in Uganda: "When she sees other children getting the same medication, she will feel not alone."

Abstract

Tuberculosis preventive treatment (TPT) uptake among children at risk for TB remains low in sub-Saharan Africa. Community-based TPT delivery is effective at increasing uptake and completion in children compared to clinic-based models, but implementation research is needed to inform scale-up in real-world settings. In this qualitative study, we assessed community and health care provider perspectives on the anticipated benefits and barriers of a community-based TPT differentiated delivery model comprising three components: (1) initial screening and TPT initiation at the nearest public health facility; (2) community health worker (CHW)-led TB education with community-based medication delivery; and (3) CHW-facilitated delivery in a Community Adherence Group (CAG). From 5 September to 12 October 2023, we conducted in-depth semi-structured interviews (N = 20) with a purposively selected sample of six public health care providers, four CHWs, and ten caregivers of children with latent TB infection. A six-person multi-regional research team translated and coded transcripts. Framework analysis was used to identify perceived benefits and barriers. Participants identified five main benefits: (1) comfort receiving care in the community due to familiarity with differentiated HIV care models and trust in CHWs; (2) peer support in CAGs promoting adherence and reducing stigma; (3) reduced transport costs; (4) improved efficiency through reduced waiting times and provider workload; and (5) enhanced CHW capacity to provide TB prevention services and increase community awareness. Perceived barriers included low community knowledge, need for a consistent drug supply, stigma, and inadequate CHW training. Caregivers, healthcare workers, and CHWs identified peer support, trust in CHWs, reduced transport costs, and increased efficiency as key benefits. Implementation efforts should address these barriers to optimize delivery in rural East Africa and similar settings. Integration of CAGs into community-based TPT models warrants further study.