Trial reportBMC health services research2024
Health care providers acceptance of default prescribing of TB preventive treatment for people living with HIV in Malawi: a qualitative study.
Trial report in BMC health services research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
5 citing papers in PubMed, 5 citations in OpenAlex.
- An evaluation of a choice architecture-based intervention on prescribing of TB preventive treatment to people living with HIV in southern Africa (the CAT study): a cluster-randomised trial.BMJ global health · 2025Trial
- Health system-related barriers and facilitators to tuberculosis preventive treatment: a qualitative case study comparing implementation in the Republic of Moldova and Georgia.BMJ open respiratory research · 2025Article
- Choice-architecture TB preventive therapy prescribing for HIV patients in Mozambique.Public health action · 2025Article
- Acceptability of workplace choice architecture modification for healthy behaviours.BMC public health · 2023Article
- Clinic and Provider Innovations to Improve Tuberculosis Infection Screening and Preventive Therapy Uptake in Brazil: Qualitative Findings From the PREVINE-TB Study.Journal of the International Association of Providers of AIDS CareArticle
Corrections and comments
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Authors and funding
9 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTuberculosis (TB) preventive treatment (TPT) substantially reduces the risk of developing active TB for people living with HIV (PLHIV). We utilized a novel implementation strategy based on choice architecture (CAT) which makes TPT prescribing the default option. Through CAT, health care workers (HCWs) need to "opt-out" when choosing not to prescribe TPT to PLHIV. We assessed the prospective, concurrent, and retrospective acceptability of TPT prescribing among HCWs in Malawi who worked in clinics participating in a cluster randomized trial of the CAT intervention.
methods28 in-depth semi-structured interviews were conducted with HCWs from control (standard prescribing approach) and intervention (CAT approach) clinics. The CAT approach was facilitated in intervention clinics using a default prescribing module built into the point-of-care HIV Electronic Medical Record (EMR) system. An interview guide for the qualitative CAT assessment was developed based on the theoretical framework of acceptability and on the normalization process theory. Thematic analysis was used to code the data, using NVivo 12 software.
resultsWe identified eight themes belonging to the three chronological constructs of acceptability. HCWs expressed no tension for changing the standard approach to TPT prescribing (prospective acceptability); however, those exposed to CAT described several advantages, including that it served as a reminder to prescribe TPT and routinized TPT prescribing (concurrent acceptability). Some felt that CAT may reduce HCW´s autonomy and might lead to inappropriate TPT prescribing (retrospective acceptability).
conclusionsThe default prescribing module for TPT has now been incorporated into the point-of-care EMR system nationally in Malawi. This seems to fit the acceptability of the HCWs. Moving forward, it is important to train HCWs on how the EMR can be leveraged to determine who is eligible for TPT and who is not, while acknowledging the autonomy of HCWs.
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