Browsing by Author "Sekaggya-Wiltshire, Christine"

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    Barriers and facilitators to integrating tuberculosis treatment into community pharmacies for people with TB/HIV in Kampala, Uganda: A qualitative study
    (PLOS, 2025-11-21) Izudi, Jonathan; Cattamanchi, Adithya; Sekaggya-Wiltshire, Christine; Kiwanuka, Noah; Sammann, Amanda; King, Rachel
    Community pharmacies (private retail drug shops or pharmacies) have proven successful for delivering anti-retroviral therapy to people living with human immunodeficiency virus (HIV). Leveraging this model for tuberculosis (TB) treatment integration could improve access to both TB and HIV treatment among people with TB/HIV. We identified the barriers and facilitators to integrating TB treatment into community pharmacies for people with TB/HIV in Kampala, Uganda, using a qualitative study across six public health facilities. Participants included people with TB/HIV; healthcare providers (HCPs) from the six facilities and their affiliated community pharmacies; and experts from the Ministry of Health. Data were collected through interviews guided by the Consolidated Framework for Implementation Research (CFIR). We performed framework analysis and mapped the emergent sub-themes to the relevant CFIR domains. We enrolled 47 participants: six TB focal persons, six HIV focal persons, nine pharmacy HCPs, three Ministry of Health staff, and 23 people with TB/HIV. Major facilitators included the convenience of accessing both TB and HIV treatment at a single location; enhanced privacy and reduced stigma; improved accessibility through extended hours, shorter wait times, and proximity; readiness of community pharmacy HCPs to deliver TB treatment; willingness of people with TB/HIV to engage in self-managed care; and training of pharmacy HCPs in TB care. Key barriers included unclear eligibility criteria for enrolling people with TB/HIV, absence of TB counseling services at pharmacies, inadequate infrastructure for TB drug storage, limited confidence among pharmacy HCPs in delivering TB care, and unclear logistics and operational procedures for implementation. Therefore, context-specific interventions that are developed in collaboration with key stakeholders, address barriers like eligibility criteria refinement, enhanced pharmacy HCP training, and financial incentives, and leverage facilitators like policy support and stakeholder readiness, are needed for the successful integration of TB treatment into community pharmacies for people with TB/HIV in Uganda.
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    Missed opportunities in engaging community pharmacies for integrated tuberculosis care in Sub-Saharan Africa: A Call to Action.
    (American Society of Tropical Medicine and Hygiene (ASTMH), 2025-11-06) Izudi, Jonathan; Sekaggya-Wiltshire, Christine; Adithya, Cattamanch
    Tuberculosis (TB) remains a leading cause of morbidity and mortality in sub-Saharan Africa. Community pharmacies, which are often the first point of contact for people with TB, are underutilized in expanding TB care. Engaging community pharmacies in TB care could facilitate personalized adherence counseling, the timely detection and reporting of medication side effects, and the integration of TB and HIV services for individuals with both TB and HIV. Pharmacies can reduce stigma and address social and psychological barriers by offering person-centered care in convenient, accessible settings, including for working people and hard-to-reach communities. Integrating community pharmacies into national TB programs could strengthen adherence, reduce loss to follow-up, improve case detection, and help achieve End TB Strategy goals. The authors of the present study advocate for deliberate policy, training, and data linkages to realize this scalable opportunity, including implementation research.
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    Person-centered strategies for integrating TB treatment into community pharmacies for people with TB/HIV in Uganda: A human-centered design methodology study protocol
    (PLOS, 2026-03-12) Izudi, Jonathan; Cattamanchi, Adithya; Sekaggya-Wiltshire, Christine; King, Rachel; Kiwanuka, Noah; Sammann, Amanda
    Background Community pharmacies (private retail drug shops or pharmacies) have successfully delivered antiretroviral therapy (ART) to people with human immunodeficiency virus (HIV) and could support integrated tuberculosis (TB) treatment, but the implementation strategies are unclear. To inform a planned pilot randomized trial, we aim to develop person-centered strategies for integrating TB treatment into community pharmacies targeting people with TB/HIV using a Human-Centered Design (HCD) methodology. Here, we describe the study protocol. Methods We will employ a three-phased HCD methodology comprising inspiration, ideation, and implementation across six primary health facilities in Kampala, Uganda. Eligible participants will include people with TB/HIV, focal persons for TB and HIV, Ministry of Health officials, and community pharmacy healthcare providers. The inspiration phase will build the themes on barriers and facilitators to integrating TB treatment into community pharmacies from a qualitative study, complemented by participant observations at selected 2–3 community pharmacies to understand the care pathway of people with TB/HIV (journey mapping), including sketching the ideal pharmacy-based TB treatment pick-up. The ideation phase will use design workshops to consolidate identified themes, generate insight statements, including translating them into design opportunities, and conclude with forming low and high-fidelity prototypes. The implementation phase will comprise two rounds of prototype testing, low and high fidelity, with 12–16 participants per round, including people with TB/HIV, focal persons, Ministry of Health officials, and pharmacy health workers. Feedback on usability, desirability, feasibility, and viability will guide iterative refinement, with high-scoring prototypes in system usability surveys prioritized for trial. Discussion Through iterative user engagement, we will adapt contextually relevant strategies that will leverage key facilitators and address barriers to TB treatment integration. Strategies demonstrating perceived usefulness, user-friendliness, high acceptability, person-centeredness, and contextual relevance will be adapted and piloted in a planned randomized trial aiming to determine feasibility, acceptability, and fidelity, including preliminary effectiveness.
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    Rapid review of community pharmacies and potential for expanded access for the treatment of HIV infection and/or tuberculosis in Sub-Saharan Africa
    (American Society of Tropical Medicine and Hygiene, 2026-04-09) Izudi, Jonathan; Ng’oda, Maurine; Sekaggya-Wiltshire, Christine; Sammann, Amanda; Kiwanuka, Noah; King, Rachel; Cattamanchi, Adithya
    Community pharmacies (private retail drug shops or pharmacies) have emerged as promising platforms for antiretroviral therapy delivery. This rapid review synthesizes findings on using pharmacies to treat HIV infection and/or tuberculosis (TB), and it identifies lessons for expanding TB service delivery. We reviewed studies published between 2015 and 2025 with adherence, retention in care, virologic suppression, prescription refill rates, and TB treatment access as outcomes. Of 314 articles screened, only 3 met the eligibility criteria (studies reporting pharmacies treating HIV infection and/or TB). Findings revealed improved CD4 cell counts; improved mean body weight; and higher rates of prescription refill (95–100%), retention (98%), and viral suppression (99%). Pharmacies have proven effective in delivering treatment for people with HIV and/or TB, highlighting their potential role in expanding TB treatment and related services in sub-Saharan Africa. However, pilot studies are needed to assess the effectiveness and implementation outcomes before broader implementation.