Background
Tuberculosis preventive therapy (TPT) is a key intervention for tuberculosis (TB) elimination. The introduction of long acting (LA) TPT has the potential to enhance adherence, minimize treatment interruptions, improve completion rates, and extend protection against tuberculosis.
Methods
We conducted a cross-sectional in-person survey among patients in two high-burden TB countries to evaluate preferences, and concerns about LA formulations for TPT. The survey compared oral medication to long-acting injections; implants; and microneedle patches. An online survey of healthcare providers (HCP) in low- and middle-income countries (LMIC) assessed attitudes toward and perceived feasibility of implementing LA formulations of TPT. Data are summarized by descriptive statistics.
Results
We recruited 409 patients (India, n = 209; South Africa, n = 200) and 94 HCPs from 25 LMIC. Mean age of patient respondents was 40; 35% were male, and 26% reported a history of TPT. Injectable TPT was the most preferred modality, followed by pills, implants, and lastly microneedle patches (Figure 1a). Notably, 304 patients (75%) expressed a strong willingness to try injectable TPT, particularly among those with prior use of injectable medication compared to those without (73% versus 27%; p <0.001). 207 (68%) of patients thought injectable TPT would be the most effective. Among parents and guardians, 75% (132 of 176) of those with children <12 years and 79% (127 of 161) of those with children ≥12 years were willing to have their child receive injectable TPT. For adults, the perceived benefits of injectables compared to pills included ease of administration (79%) and perceived efficacy (75%). However, 45% of patients expressed concern about the potential ineffectiveness and prolonged side effects of injections (40%). 90% (73/81) of providers were willing to prescribe LA TPT if efficacy, safety, and cost are comparable to oral medication. Among providers, 43% (34/79) favoured injectables, while 18% (14/79) favoured implants and 13% (10/79) patches (Figure 1b). Cost emerged as a significant factor influencing providers’ willingness to adopt LA TPT, with 75% willingness if cost is comparable to oral medication compared to 25% if cost were doubled.
Conclusions
Injectable TPT was the preferred LA TPT formulation among patients and providers in our survey. At scale, injectable TPT may be highly acceptable and feasible if concerns of cost and safety are addressed.