Choice-architecture TB Preventive Therapy Prescribing for HIV Patients in Mozambique

Overview

Journal Public Health Action

Date 2025 Mar 3

PMID 40028639

Authors

I Salles

S Munguambe

R Chiau

E Valverde

J E Golub

C J Hoffmann

K Shearer

Affiliations

Soon will be listed here.

Abstract

Introduction: Despite the effectiveness of TB preventive treatment (TPT) in reducing TB incidence and mortality among people living with HIV (PLHIV), uptake has been low. We conducted a cluster randomised trial to evaluate a choice architecture-based intervention for prescribing TPT (the 'CAT' study) to PLHIV in Mozambique, nested within the short-course 3HP regimen roll-out, and qualitatively assessed intervention acceptability and feasibility with healthcare workers (HCWs).

Methods: The CAT intervention comprised training on default TPT prescribing and prescribing stickers integrated into antiretroviral therapy (ART) stationery. We assessed intervention acceptability and feasibility to increase TPT prescribing through 25 in-depth interviews (IDIs) with HCWs from participating clinics between August and September 2022. Thematic analysis of the IDIs identified key themes.

Results: Participants reported a positive impact of the intervention on patient care, though workload opinions varied. Participants reported that CAT did not significantly alter routine TPT prescribing processes but highlighted the need for reminders and decision-support tools. CAT was viewed to streamline patient management, particularly identifying eligible TPT patients and simplifying documentation.

Conclusion: The CAT strategy could enhance TPT delivery to PLHIV and integrate it into preventive care for other diseases.

References

Soh Q, Oh L, Chow E, Johnson C, Jamil M, Ong J . HIV Testing Uptake According to Opt-In, Opt-Out or Risk-Based Testing Approaches: a Systematic Review and Meta-Analysis. Curr HIV/AIDS Rep. 2022; 19(5):375-383. PMC: 9508204. DOI: 10.1007/s11904-022-00614-0. View

Caturegli G, Materi J, Lombardo A, Milovanovic M, Yende N, Variava E . Choice architecture-based prescribing tool for TB preventive therapy: a pilot study in South Africa. Public Health Action. 2020; 10(3):118-123. PMC: 7577007. DOI: 10.5588/pha.20.0020. View

Wambiya E, Atela M, Eboreime E, Ibisomi L . Factors affecting the acceptability of isoniazid preventive therapy among healthcare providers in selected HIV clinics in Nairobi County, Kenya: a qualitative study. BMJ Open. 2018; 8(12):e024286. PMC: 6303693. DOI: 10.1136/bmjopen-2018-024286. View

Johnson E, Goldstein D . Medicine. Do defaults save lives?. Science. 2003; 302(5649):1338-9. DOI: 10.1126/science.1091721. View

van de Water B, Wilson M, le Roux K, Gaunt B, Gimbel S, Ware N . Healthcare worker perceived barriers and facilitators to implementing a tuberculosis preventive therapy program in rural South Africa: a content analysis using the consolidated framework for implementation research. Implement Sci Commun. 2023; 4(1):107. PMC: 10468851. DOI: 10.1186/s43058-023-00490-8. View

Patel M, Volpp K, Asch D . Nudge Units to Improve the Delivery of Health Care. N Engl J Med. 2018; 378(3):214-216. PMC: 6143141. DOI: 10.1056/NEJMp1712984. View

Mehta S, Khan T, Guerra C, Reitz C, McAuliffe T, Volpp K . A Randomized Controlled Trial of Opt-in Versus Opt-Out Colorectal Cancer Screening Outreach. Am J Gastroenterol. 2018; 113(12):1848-1854. PMC: 6768589. DOI: 10.1038/s41395-018-0151-3. View

Floridia M, Ciccacci F, Andreotti M, Mutemba E, Paulo A, Xavier M . Low mortality rates at two years in HIV-infected individuals undergoing systematic tuberculosis testing with rapid assays at initiation of antiretroviral treatment in Mozambique. Int J Infect Dis. 2020; 99:386-392. DOI: 10.1016/j.ijid.2020.08.016. View

Leidel S, Leslie G, Boldy D, Davies A, Girdler S . 'We didn't have to dance around it': opt-out HIV testing among homeless and marginalised patients. Aust J Prim Health. 2017; 23(3):278-283. DOI: 10.1071/PY16120. View

10.

Patel M, Volpp K, Small D, Wynne C, Zhu J, Yang L . Using Active Choice Within the Electronic Health Record to Increase Influenza Vaccination Rates. J Gen Intern Med. 2017; 32(7):790-795. PMC: 5481246. DOI: 10.1007/s11606-017-4046-6. View

11.

Teklay G, Teklu T, Legesse B, Tedla K, Klinkenberg E . Barriers in the implementation of isoniazid preventive therapy for people living with HIV in Northern Ethiopia: a mixed quantitative and qualitative study. BMC Public Health. 2016; 16(1):840. PMC: 4992328. DOI: 10.1186/s12889-016-3525-8. View

12.

Lester R, Hamilton R, Charalambous S, Dwadwa T, Chandler C, Churchyard G . Barriers to implementation of isoniazid preventive therapy in HIV clinics: a qualitative study. AIDS. 2010; 24 Suppl 5:S45-8. DOI: 10.1097/01.aids.0000391021.18284.12. View

13.

Ayele H, van Mourik M, Debray T, Bonten M . Isoniazid Prophylactic Therapy for the Prevention of Tuberculosis in HIV Infected Adults: A Systematic Review and Meta-Analysis of Randomized Trials. PLoS One. 2015; 10(11):e0142290. PMC: 4638336. DOI: 10.1371/journal.pone.0142290. View

14.

Balasubramanian R, Shearer K, Mudzengi D, Hippner P, Golub J, Chihota V . Modeling the impact of universal tuberculosis molecular testing and timing of tuberculosis preventive treatment during antiretroviral therapy initiation in South Africa. AIDS. 2023; 37(15):2371-2379. PMC: 10782927. DOI: 10.1097/QAD.0000000000003707. View

15.

Akolo C, Adetifa I, Shepperd S, Volmink J . Treatment of latent tuberculosis infection in HIV infected persons. Cochrane Database Syst Rev. 2010; (1):CD000171. PMC: 7043303. DOI: 10.1002/14651858.CD000171.pub3. View

16.

De Groot L, Shearer K, Sambani C, Kaonga E, Nyirenda R, Mbendera K . Health care providers acceptance of default prescribing of TB preventive treatment for people living with HIV in Malawi: a qualitative study. BMC Health Serv Res. 2024; 24(1):15. PMC: 10768226. DOI: 10.1186/s12913-023-10493-9. View

17.

Mindachew M, Deribew A, Tessema F, Biadgilign S . Predictors of adherence to isoniazid preventive therapy among HIV positive adults in Addis Ababa, Ethiopia. BMC Public Health. 2011; 11:916. PMC: 3270073. DOI: 10.1186/1471-2458-11-916. View

18.

Sekhon M, Cartwright M, Francis J . Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017; 17(1):88. PMC: 5267473. DOI: 10.1186/s12913-017-2031-8. View

19.

Mishra A, Mabuto T, Shearer K, Trujillo A, Golub J, Hoffmann C . Strengthening HIV and HIV co-morbidity care in low- and middle-income countries: insights from behavioural economics to improve healthcare worker behaviour. J Int AIDS Soc. 2023; 26(4):e26074. PMC: 10071072. DOI: 10.1002/jia2.26074. View

20.

Lai J, Dememew Z, Jerene D, Abashawl A, Feleke B, Teklu A . . Int J Tuberc Lung Dis. 2019; 23(3):371-377. PMC: 6822021. DOI: 10.5588/ijtld.18.0378. View