Contextualizing and optimizing novel strategies to improve the latent TB continuum of care: Insights from people living with HIV and health care providers in Brazil

• DOI: 10.1371/journal.pgph.0001251
• Publication Date: 2023-01-04T18:23:50Z
• Authors: Isadora Salles; Paula Travassos; Renata Spener-Gomes; Ana Paula Loch; Valeria Saraceni; Lilian Lauria; Solange Cavalcante; Jamile Garcia de ...; Alexandra Brito d...; Allyson Guimarães...; Sumire Sakabe; Roberta Schiavon ...; Lelia H. Chaisson; Silvia Cohn; Leda Fatima Jamal; Jose Valdez Ramal...; Marcelo Cordeiro-...; Barbara Castro; Danielle Portella...; Christopher J. Ho...; Jonathan E. Golub; Betina Durovni; Deanna Kerrigan
• Keywords: Rifapentine; Stigma; Staffing

Tuberculosis (TB) causes 1 in 3 deaths among people living with HIV (PLHIV). Diagnosing and treating latent tuberculosis infection (LTBI) is critical to reducing TB incidence mortality. Blood-based screening tests (e.g., QuantiFERON-TB Gold Plus (QFT+)) shorter-course preventive therapy (TPT) regimens such as 3HP (3 months weekly isoniazid-rifapentine) hold significant promise improve outcomes. We qualitatively explored barriers solutions optimizing QFT+ PLHIV three cities Brazil. conducted 110 in-depth interviews PLHIV, health care providers (HCP) key informants (KI). Content analysis was including the use of case summaries comparison themes across populations contexts. LTBI treatment practices were dependent on HCP’s perceptions whether they improving Many HCP lacked a strong understanding perceived current TPT regimen complicated. reported that constrained by clinic staffing challenges. While generally expressed willingness consider any test or doctors recommended, indicated rarely discussed TPT. testing requests structural factors financial food insecurity, difficulties leaving work for appointments, stigma family responsibilities. viewed all participants tools could significantly cascade avoiding complexities skin longer courses. have challenges, potential increase workload over-burdened systems if not implemented alongside improved supply chains, staffing, training, follow-up initiatives. Multi-level interventions importance HCP, patient-provider communication, streamline clinic-level operations related are needed optimize their impact reduce