Implementation challenges of 3-month once-weekly rifapentine and isoniazid TB-preventive treatment in India

Implementing three months of once-weekly rifapentine and isoniazid (3HP) for tuberculosis preventive therapy among household contacts (HHCs) of bacteriologically confirmed pulmonary TB patients in India presents programmatic challenges requiring understanding from beneficiary and provider perspectives.

From May 2023 to March 2024, nine focus group discussions were conducted across five rural and urban program settings: three with HHCs who received 3HP (n=28) and six with frontline healthcare providers (n=69) delivering the regimen within a multicentric implementation study. Descriptive thematic analysis explored experiences, perceptions, and implementation challenges.

Analysis of FGDs yielded four major themes: (i) perceptions and acceptance of 3HP; (ii) barriers to 3HP; (iii) advocacy and communication and social mobilization; and (iv) suggestions for improving 3HP. Participants appreciated the short, once-weekly regimen and family encouragement supporting adherence. However, reluctance to undergo testing without symptoms, fear of side effects, stigma, and access barriers limited uptake. Suggested solutions included transport support, mobile X-ray services, reminder tools, and family DOTS providers. Providers highlighted workforce shortages and the need for additional staff.

Both groups emphasized tailored counselling, strengthened community awareness, and media advocacy to improve uptake, adherence, and program sustainability of 3HP implementation at scale nationwide.