Abstract:
BACKGROUND : TB preventive therapy (TPT) is critical
for ending TB, yet implementation remains poor. With
new global guidelines expanding TPT eligibility and
regimens, we aimed to understand TPT preferences
among children, adolescents and caregivers.
METHODS : We undertook a discrete choice experiment
among 131 children, 170 adolescents and 173 caregivers,
and conducted 17 in-depth interviews in 25 clinics in
Cape Town, South Africa. The design included attributes
for location, waiting time, treatment duration,
dosing frequency, formulation/size, side effects, packaging
and taste. Mixed-effects logistic regression models
were used for analysis.
RESULTS : Among children and caregivers, the number
and size of pills, taste and side effects were important
drivers of preferences. Among adolescents and caregivers,
clinic waiting times and side effects were significant
drivers of preferences. Adolescents expressed concerns
about being stigmatised, and preferred services from
local clinics to services delivered in the community.
Dosing frequency and treatment duration were only
significant drivers of choice among adolescents, and only
if linked to fewer clinic visits.
CONCLUSIONS : Introducing shorter TPT regimens in
isolation without consideration of preferences and
health services may not have the desired effect on uptake
and completion. Developing TPT delivery models and
formulations that align with preferences must be
prioritised.
