Appropriateness, barriers, and facilitators of multi-month dispensing of tuberculosis drugs in rural eastern Uganda: A qualitative study to inform a non-inferiority randomized trial
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Date
2025-09-05
Journal Title
Journal ISSN
Volume Title
Publisher
PLOS
Abstract
Multi-month dispensing of tuberculosis (TB) drugs is an innovative strategy that may reduce frequent clinic visits and travel costs among people with TB (PWTB) in rural areas. To inform a planned trial, we explored the appropriateness, barriers, and facilitators to multi-month dispensing among PWTB and healthcare providers in rural eastern Uganda. We used qualitative methods situated within the Consolidated Framework for Implementation Research to explore two refill schedules for multi-month dispensing of TB drugs—a four- or five-visit refill schedule. In December 2024, we collected data through interviews with PWTB, their treatment supporters, and healthcare providers at the regional, district, and health facility levels. Data were analyzed using thematic analysis. All participants (n = 39; 22 healthcare providers, 12 PWTB, and five treatment supporters) expressed willingness to adopt multi-month dispensing, with a four-visit schedule as the preferred option. Healthcare providers preferred the five-visit schedule for individuals with complex health conditions: severe illness, clinical instability, or bacteriologically confirmed pulmonary TB. Multi-month dispensing was perceived to benefit healthcare providers by reducing workload, improving patient flow, and enhancing patient management. Perceived benefits to PWTB included reduced clinic visits and travel costs, time savings, improved treatment adherence, reduced wait times and TB-related stigma, and increased satisfaction with care. Facilitators included integration with existing treatment models, person-centeredness, community and family support, reliable drug supply, clear operational guidelines, healthcare provider training and readiness, enhanced monitoring and evaluation, clinic accessibility, readiness to utilize multi-month dispensing, and leadership support. Barriers included undefined eligibility criteria, uncertain effects of multi-month dispensing, differing refill schedules for PWTB and HIV, treatment non-adherence due to forgetfulness and medication sharing, and patient disengagement due to insufficient follow-up. Multi-month dispensing is perceived to benefit PWTB and healthcare providers. Further studies to measure the impact on treatment outcomes should leverage facilitators and address barriers to adoption and effectiveness.
Description
Keywords
Drug therapy, Health care facilities, Tuberculosis, Drug adherence, Uganda, Health care providers, Qualitative studies, Therapeutic drug monitoring
Citation
Izudi, J., Bajunirwe, F., Cattamanchi, A., & West, N. (2025). Addressing Stigma, Mental Well-Being, and Alcohol Use among People with Tuberculosis in Sub-Saharan Africa: A Call for an Integrated Care Model. The American journal of tropical medicine and hygiene, tpmd250048. Advance online publication. https://doi.org/10.4269/ajtmh.25-0048