Could local pharmacies deliver TB care for people with TB/HIV?

Tuberculosis (TB) remains a major global health challenge, especially for people living with human immunodeficiency virus (HIV). Community pharmacies — the private retail drug shops where many people already pick up medication — have been successful in delivering anti-retroviral therapy to people with HIV. Researchers led by Jonathan Izudi asked whether this existing model could be used to improve access to TB treatment for people with TB/HIV in Kampala, Uganda. To explore this possibility, the team conducted a qualitative study at six public health facilities and their affiliated community pharmacies in Kampala. They sought to identify what would help and what would block the integration of TB treatment into community pharmacies. Using interviews and a structured approach to study implementation, the researchers gathered views from people with TB/HIV, pharmacy and clinic healthcare providers, and Ministry of Health experts. The goal was to map practical challenges and opportunities so that any future efforts to move TB care into pharmacies would be grounded in the realities faced by patients, pharmacists and health system leaders.

The study collected interview data guided by the Consolidated Framework for Implementation Research (CFIR) and used framework analysis to organize findings. In total, 47 participants were enrolled: six TB focal persons, six HIV focal persons, nine pharmacy HCPs, three Ministry of Health staff, and 23 people with TB/HIV. From those conversations, several major facilitators emerged. Participants said it would be convenient to get both TB and HIV treatment at a single location, and that pharmacies could offer greater privacy and reduce stigma. Pharmacies also often have extended hours, shorter wait times, and are close to where people live, making care more accessible. Pharmacy HCPs showed readiness to deliver TB treatment and many people with TB/HIV were willing to engage in self-managed care, especially if pharmacy HCPs received training in TB care. At the same time, the study identified clear barriers: eligibility criteria for enrolling people with TB/HIV into pharmacy-based treatment were unclear; pharmacies lacked TB counseling services and adequate infrastructure for safe TB drug storage; some pharmacy HCPs had limited confidence in delivering TB care; and logistics and operational procedures for implementation were not well defined.

The findings point to a path forward but also to what must be resolved for pharmacy-based TB care to work. Integrating TB treatment into community pharmacies could improve access to both TB and HIV treatment, reduce stigma, and make care more convenient through proximity, extended hours and shorter waits. However, the study makes clear that policymakers and program planners cannot assume a one-size-fits-all approach. Context-specific interventions developed with key stakeholders — including people with TB/HIV, pharmacy HCPs, clinic staff and the Ministry of Health — are needed. Those interventions should refine eligibility criteria, add TB counseling services, upgrade storage infrastructure, build pharmacy HCPs’ skills and confidence through training, and clarify logistics and operational procedures. Financial incentives and policy support were also identified as elements that could help translate readiness and willingness into effective, safe services. If these steps are taken, community pharmacies in Kampala and similar settings may become important sites for delivering integrated TB and HIV care.