Tuberculosis- learning about experience with nutritional supplementation (TB LENS): Perspectives on a nutritional supplementation for persons with TB and their household contacts.

Undernutrition is a major driver of the tuberculosis (TB) epidemic, with one in five TB cases worldwide attributable to undernutrition. Nutritional interventions may reduce TB incidence and mortality for those at increased risk of developing TB. The TB LION (Tuberculosis - Learning the Impact Of Nutrition) study provides nutritional supplementation to household contacts (HHC) of TB index cases (n = 60) to examine the impact of supplementation on progression from latent to active TB disease. TB LENS (Learning about Experience with Nutritional Supplementation), a qualitative sub-study of TB LION, was designed to examine attitudes and opinions regarding the provided nutritional supplementation to inform future interventions. We conducted in-depth interviews with HHCs from the TB LION study, local healthcare workers (HCWs) treating persons with TB, and with the two lead study nutritionists. Additionally, we held focus group discussions among HHCs and HCWs. We identified barriers and facilitators to intervention uptake and perspectives for future interventions. The results demonstrate the importance of culturally acceptable interventions with foods that participants enjoy eating and can prepare quickly. We also found an overwhelming preference for in-kind food delivery to the home over cash transfers. These results can inform future interventions to improve nutrition for households with TB.