Integrating community pharmacists in tuberculosis infection care: challenges and strategic approaches in Indonesia

Community pharmacists (CPs) are accessible healthcare providers with the potential to support care for tuberculosis infection (TBI). However, their role remains limited and poorly integrated into national TB programs. Despite global recognition, no study in Indonesia has explored how CPs can be engaged as direct service providers. This study aims to identify the challenges and develop strategies for involving CPs as direct providers of TB services to improve TB preventive treatment outcomes.

A qualitative case study was conducted in West Java, Indonesia. Data collection involved group interviews (GIs) and in-depth interviews (IDIs) with providers from community health centers (CHCs) and community pharmacies, as well as with patients with TBI. Participants responded to a proposed collaborative model scenario during the interviews, where CPs would provide direct support for TBI treatment. Data were deductively analyzed using ATLAS.ti version 9, employing a thematic analysis approach guided by the Tailored Implementation for Chronic Diseases (TICD) framework to identify challenges and strategies across seven domains. The findings are reported in accordance with the 32-item COREQ checklist.

A total of 27 participants were enrolled from CHCs and pharmacies, including TB programmers, medical doctors, community pharmacists, and individuals with TBI. We identified several challenges, including the absence of specific guidelines; limited knowledge and skills among CPs; patient preferences; limited professional interaction between CPs and healthcare workers; the lack of an incentive scheme; and insufficient regulatory support from national and local governments. In response to these challenges, various strategies can be implemented, including providing systematic guidelines, improving CPs' capacity, building a communication system between CPs and related healthcare workers, implementing an incentive scheme, and advocating for regulatory support from national and local governments.

To implement collaborative practice effectively, it is essential to address the identified challenges and, alongside coordinated efforts among all TB stakeholders, develop strategies to establish a sustainable, impactful practice model in real-world settings.