Giving TB medicine for months at a time could help rural patients

Tuberculosis treatment usually requires frequent visits to health clinics to pick up medication, a burden that is especially heavy for people with TB (PWTB) living in rural areas. These trips cost time and money and can make it harder for people to stay on treatment. To explore a way to reduce that burden, researchers led by Jonathan Izudi carried out a qualitative study in rural eastern Uganda to inform a planned non-inferiority randomized trial. In December 2024 they interviewed people with TB, their treatment supporters, and healthcare workers at regional, district and health facility levels to learn whether multi-month dispensing of TB drugs would fit local needs, what might help make it work, and what could get in the way. The researchers focused on two possible refill schedules — a four-visit plan and a five-visit plan — and set their work inside the Consolidated Framework for Implementation Research to make sure they considered practical issues of adopting the approach in routine care.

The team used qualitative methods and analyzed interview material with thematic analysis. They spoke with 39 people in total: 22 healthcare providers, 12 PWTB, and five treatment supporters. Across the interviews, every participant expressed willingness to try multi-month dispensing, with the four-visit schedule most often preferred. Healthcare providers, however, said they would favor the five-visit schedule for people with complex conditions such as severe illness, clinical instability, or bacteriologically confirmed pulmonary TB. Participants described several benefits: for healthcare workers, multi-month dispensing could reduce workload, improve patient flow, and make patient management easier; for PWTB, it could cut clinic visits and travel costs, save time, improve treatment adherence, shorten waiting times, reduce TB-related stigma, and increase satisfaction with care. The study also identified facilitators — for example, integration with existing treatment models, person-centered care, community and family support, reliable drug supply, clear operational guidelines, healthcare provider training and readiness, better monitoring and evaluation, clinic accessibility, patient readiness to use the system, and leadership support — and barriers such as undefined eligibility criteria, uncertain effects of multi-month dispensing, differing refill schedules for PWTB and HIV, risks of non-adherence from forgetfulness and medication sharing, and possible patient disengagement if follow-up is insufficient.

The findings suggest multi-month dispensing is broadly acceptable and seen as beneficial by both patients and providers in this rural Ugandan setting. For a planned non-inferiority randomized trial, these results point to practical steps: use the preferred four-visit schedule for most patients while reserving a more frequent five-visit schedule for clinically complex cases; ensure clear eligibility rules and operational guidance; secure a reliable drug supply; and provide training and monitoring to prevent medication sharing and loss to follow-up. The study underlines that practical facilitators — from family support to clinic accessibility and leadership buy-in — will be important to scale up any multi-month dispensing program. At the same time, policymakers and implementers should address the identified barriers before broad adoption. Further studies should now measure the actual impact of multi-month dispensing on treatment outcomes, using the facilitators and fixes for barriers identified here to give the approach its best chance of working in rural settings.