A mixed-method study to inform the development of long-acting injectable TB treatments

BACKGROUND: Development of long-acting injectable (LAI) formulations of TB drugs could transform global TB management. We assessed three hypothetical LAI treatment scenarios and seven product-specific characteristics among TB patients and survivors, TB clinicians, and other key stakeholders. METHODS: A two-stage, mixed-method study was conducted in the Philippines. Stage 1 included semi-structured interviews with 15 key informants (KIs) from public health organisations, government, and clinical practices. Stage 2 entailed face-to-face surveys and a discrete choice experiment (DCE) with TB health providers (n = 51), adult TB patients on treatment (n = 247), and TB survivors (n = 54) in one urban and one semi-urban setting. RESULTS: Common themes identified through KI interviews included goals of minimising treatment burden, maximising adherence and efficacy, primary care setting preference, and the ability to monitor response. Relative to the oral standard of care, most participants reported that the LAI TB treatment scenarios were acceptable. Body placement of the injection was a driving characteristic of treatment choice for patients; preference for LAI treatment delivered through a primary care setting was reported as positively influencing treatment choice across respondent types. CONCLUSION: Multi-setting stakeholder input should guide development of LAI TB treatment so that developers can aim for acceptable product characteristics.