Optimizing delivery strategies for 3HP TB preventive treatment in Tanzania: A qualitative study on acceptability of family approach in HIV care and treatment centers

Introduction Tanzania rolled-out a 12-dose, weekly regimen of isoniazid plus rifapentine (3HP) TB preventive treatment in January, 2024. Although 3HP completion rate is generally ≥80%, variations exist depending on type of delivery strategy and programmatic setting. Prior to the roll-out, a mixed methods study was conducted to assess whether a family approach involving family member support, SMS reminders and three health education sessions, was acceptable and optimized 3HP uptake and completion. This paper describes acceptability of the family approach among people living with HIV (PLHIV), treatment supporters (TS) and community health workers (CHWs). Methods This was a qualitative descriptive study in 12 HIV care and treatment centers across six administrative regions. We purposively sampled 20 PLHIV, 12 CHWs for in-depth interviews and 23 TS for three focus group discussions held between September to December, 2023. The theoretical framework of acceptability guided thematic-content analysis using a framework approach. Results Participants understood that PLHIV have high risk for active TB and that 3HP provides shortened treatment for TB disease prevention. They reported gaining TB and 3HP knowledge from health education sessions. However, participation of TS in health education sessions was low and many reported expensive transportation costs to clinics. Receiving support from someone close and SMS were perceived as good adherence reminders. The majority reported mild self-limiting side effects but expressed positive attitudes because of the shortened treatment, TB counselling, satisfaction from helping others, alignment with lifestyle and work responsibilities and reduced work burden. Some PLHIV reported difficulties in identifying family members for support thus, chose other close friends or CHWs. Conclusions Delivery of 3HP with support from family members and SMS reminders is widely accepted by CHWs, PLHIVs and TS. Restricting support from only family members was unacceptable and attendance of all three health education sessions by TS may not be feasible. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Global Fund through the National AIDS, STIs & Hepatitis Control Programme (NASHCoP), grant name TZA-H-MOF and grant number 1961. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Mbeya Medical Research and Ethics Review Committee (MMREC). An ethics approval was granted for the study I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Study participants were assured of data confidentiality when securing informed consent. Some of the interview transcripts contain identifiable information thus, making raw data available will be a breach to confidentiality. The data that support the study findings are available from the corresponding author upon reasonable request. Please contact dpamba@nimr-mmrc.org for data availability requests.