TB will never end because of us: Experiences of TB preventive treatment among people living with HIV/AIDS in South Africa.

BACKGROUND

Tuberculosis (TB) remains a major global health challenge, particularly for people living with HIV/AIDS (PLWHA). TB preventive treatment (TPT) has been found to reduce the risk of TB among PLWHA. As TPT has become a standard component of HIV care, understanding client-level perceptions and knowledge of TPT is crucial to optimizing uptake.

METHODS

This qualitative sub-study was conducted within a cluster-randomized trial evaluating a TPT initiation strategy in two provinces of South Africa. The qualitative component explored patient understanding and experiences with HIV, TB, and TPT through in-depth interviews. PLWHA receiving care at participating public-sector healthcare facilities in the North West and Free State provinces were systematically purposively selected. Thematic analysis was used to identify themes.

RESULTS

Thirty-three adult PLWHA were interviewed. Most participants understood TB, household transmission risk, and that PLWHA are more susceptible to TB. Participants were aware TB is curable and associated its risk and transmission to dirty environments, neglecting flu-like symptoms and lifestyle habits (alcohol use and smoking). Participants highlighted that health-seeking behaviors, treatment adherence, and community perception influence TB burden, stressing TB prevention and treatment as community challenges. Knowledge of TPT varied, with most participants emphasizing the need for clients to take initiative in their treatment. Participants requested that healthcare workers provide more details about TPT through posters and pamphlets in clinics, and suggested community engagement to encourage uptake. While adherence was acknowledged, concerns included side effects and the burden of taking both antiretroviral therapy and TPT.

CONCLUSION

Individual and community social and health-related factors, along with acceptability of TPT, might affect uptake and retention. While TPT was seen as important, concerns about side effects and dual treatment burdens highlight the need for improved education and support. Strengthening healthcare communication, expanding TPT information, and promoting TPT as a proactive health decision may motivate uptake.