Challenges in the implementation of preventive treatment for tuberculosis in people living with HIV/Aids: A qualitative study

Treatment of tuberculosis infection (TBI) in people living with HIV/Aids (PLWHA) reduces the risk of tuberculosis disease (TBD), the main cause of death in this population. Recognizing the barriers related to the scale up of tuberculosis preventive treatment (TPT) can contribute to reorganization of health services for achieving TB elimination. This qualitative study aimed to understand the perception of specialized care health professionals of a capital city in Brazil about TPT for PLWHA. Between October 2020 and August 2022 ten physicians and four nurses working for more than six months in reference HIV/Aids services were interviewed. Interviews were guided by a script of previously validated, semi-structured questions. The audios were recorded, transcribed, and categorized based on Grounded Theory, and its analysis was anchored in the theoretical framework of Symbolic Interactionism. Sampling was performed using theoretical saturation. The emerged central phenomenon “Facing challenges in the implementation of TPT in the light of scientific evidence” was supported by four categories:1) Demonstrating theoretical knowledge regarding TBI and its treatment guidelines; 2) Dealing with the complexities of guidelines adherence in the routine service; 3) Building bonds to overcome different challenges in the care of PLWHA; 4) Seeking strategies to facilitate adherence to the TPT guidelines service. Professionals faced challenges in implementing TPT due to structural obstacles in service, hesitation in establishing therapy, and the risk of adverse events when dealing with patients’ vulnerabilities, despite available scientific evidence, theoretical knowledge, and guidelines recommendations. They envisaged ideal conditions to adhere to the TPT guidelines in service, and seeked to mediate confrontations by strengthening their bond with patients through multidisciplinary interaction, teaching, and research. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was conducted in accordance with the tenets of Declaration of Helsinki. It was approved by the Ethics Committee for Research with Human Beings of the Federal University of Mato Grosso do Sul on November 2, 2020 (# 4.375.024). Written informed consent was obtained from all the study participants. To maintain secrecy and anonymity, the participants were represented by the letter “P” followed by the number corresponding to the order of the interviews (P1, P2, P3 ...). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.