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

Dados Bibliográficos

ID19592003
AutoresJonathan Izudi (0000-0001-9065-0389, Mbarara University of Science and Technology, autor correspondente), Francis Bajunirwe (0000-0002-1326-5230, Mbarara University of Science and Technology, autor correspondente), Adithya Cattamanchi (0000-0002-6553-2601, University of California, Irvine, autor correspondente), Nora S West (0000-0001-8556-1744, San Francisco General Hospital, autor correspondente)
EditoresShiyam Sunder
Ano2025
Volume5
Fascículo9
Páginase0004539
Data de publicação2025-09-05
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoPLOS Global Public Health (JOURNAL)
Identificadores do periódicoISSN: 2767-3375 • E-ISSN: 2767-3375
EditoraPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0004539
PMID40911557
OpenAlexW4414040618
IdiomaEN
Referências citadas23

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

Health care · Patient satisfaction · Qualitative property · Qualitative research · Randomized controlled trial · Rural health · Schedule · Thematic analysis · Tuberculosis · Global Maternal and Child Health · Pharmaceutical Economics and Policy · Tuberculosis Research and Epidemiology