BACKGROUND: TB preventive treatment (TPT) coverage for HIV-positive Zimbabweans is suboptimal. As stable patients on antiretroviral therapy (ART) are shifted into less-intensive differentiated service delivery models (DSDM), opportunities to expand TPT coverage and completion may emerge. ICAP and the Zimbabwe Ministry of Health and Child Care (MoHCC) assessed the feasibility and acceptability of integrating TPT into community antiretroviral refill groups (CARGs).
METHODS: We conducted 25 'central-level' key informant interviews (KII) with MoHCC staff, implementers, and clinicians; 20 KII with CARG leaders; 16 focus group discussions (FGD) with 136 CARG members (half of whom had received TPT); and 8 field-based observations of CARG meetings. CARG leader KIIs, FGDs, and CARG observations were conducted at 4 urban and 3 rural health facilities. KIIs and FGDs were transcribed and analyzed using DedooseÃ? software with thematic coding and content analysis. Closed-ended questions from KIIs and FGDs and the field-based observations were analyzed using STATA.
RESULTS: 96% of central-level informants and 85% of CARG leaders described providing TPT via CARGs as a 'good' or 'very good' idea. When presented with hypothetical models for TPT delivery, all cadres strongly preferred approaches that included multi-month TPT dispensing, fewer clinic visits, and monitoring for side effects and incident TB symptoms by both CARG leaders and clinicians rather than the current standard of monthly clinic visits at which one months' worth of TPT is dispensed. Perceived advantages of this model included convenience and access to the ongoing adherence and psychosocial support provided by CARGs. Participants also noted that this approach would require additional training and supervision of CARG leaders. During field-based observations, 2/8 CARG leaders (25%) asked every CARG member if s/he had TB symptoms despite 17/20 (85%) mentioning TB screening as one of their main roles in interviews. 7/16 (44%) had received additional training since becoming CARG leaders in the last 2-3 years.
CONCLUSIONS: Stakeholders agreed that provision of TPT via CARGs would be a feasible and acceptable approach to increasing TPT coverage and completion in Zimbabwe. The perceived need for additional training and supervision of CARG leaders was reinforced by the observation that only 25% screened CARG members for TB symptoms.