Optimising child-friendly TB preventive treatment regimens

BACKGROUND: The World Health Organization recommends rifamycin-based TB preventive treatment (TPT) for children, but factors influencing regimen acceptability are not well understood. We explored perceptions of two short-course regimens - 3HP (weekly dosing) and 3RH (daily dosing) - among interest-holders in Ethiopia. METHODS: Forty-seven in-depth interviews were conducted with caregivers of TB-exposed children, community health workers, health care providers, and policymakers following the CHIP-TB trial, which evaluated home-based TPT delivery. Thematic content analysis was used to assess acceptability across factors such as palatability, dosing frequency, pill burden, adherence, and side effects. RESULTS: Both regimens were generally well tolerated. Caregivers reported good palatability, though some children vomited or spit out the medication. Weekly dosing with 3HP was seen as less burdensome but easier to forget, requiring additional support for adherence. Daily 3RH was considered more difficult due to the routine burden on caregivers. Interest-holders preferred 3HP overall but noted concerns about the high number of pills per dose. Mild side effects were reported with both regimens but did not result in discontinuation. CONCLUSION: Interest-holders favoured 3HP for its lower dosing burden, despite concerns about pill burden. Child-friendly, fixed-dose formulations and consideration of caregiver and child preferences are essential to improving adherence and treatment outcomes.