Feasibility and acceptability of a modified shorter all-oral bedaquiline containing MDR/RR-TB regimen in Tanzanian programmatic settings

ABSTRACT

Background: Tuberculosis prevails to be the leading cause of deaths from infectious diseases following COVID-19 in 2021. Global MDR/RR-TB cases were estimated at 3.3% and 18% of new and previously treated TB cases in 2019. The 2019 annual National Tuberculosis and Leprosy Programme (NTLP) report estimated an increase in MDR/RR-TB notification from 217 in 2015 to 534 patients in 2019 in Tanzania. The country uses a longer oral MDR/RR-TB regimen of 18 to 20 months as standard of care since November 2019 although the 2018 WHO DR TB guidelines recommended a new shorter all-oral bedaquiline-containing MDR/RR-TB regimen. Given paucity of clinical and programmatic evidence, WHO called upon operational research if pilots of the regimen are to be conducted. In response, NTLP collaborates with the National Institute for Medical Research-Mbeya Centre and Kibong'oto Infectious Diseases Hospital in conducting operational research with acronym RISE project, in 16 MDR/RR-TB facilities since June 2019 to assess the new regimen's clinical effectiveness and feasibility. Objective(s) To describe acceptability, facilitators, and barriers in implementation of a modified shorter all-oral MDR/RR-TB regimen as perceived by healthcare workers and MDR/RR-TB persons. Method(s) A qualitative descriptive study was used that purposively selected 16 MDR/RR-TB persons enrolled in MDR/RR-TB treatment facilities implementing the RISE project and 53 HCWs from respective facilities. A total of 36 IDIs and 8 focus group discussions with 33 HCWs were held at 6 and 15 months timepoints. Data were analyzed by thematic analysis using ATLAS ti. Result(s) Four themes emerged namely;preference for shorter MDR/RR TB treatment, inaccessible laboratory tests, persistent infrastructural limitations and enhanced programmatic support. Conclusion(s) The shorter all-oral bedaquilline containing regimen is acceptable by MDR/RR TB persons and providers however, financial support for patient access to safety tests and strengthening facility laboratory infrastructure is crucial for the clinical effectiveness of the regimen.