Evidence map›Paper›PMID 40412816›Full record

Trial reportBMJ global health2025

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.

Kate Shearer, Bareng A S Nonyane, Christiaan Mulder, Emmanuel Kaonga, Rose Nyirenda, Kuzani Mbendera, Clara Sambani, Emilio Valverde, Savaiva Manguambe, Rogerio Chiau and 10 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04466293 (Choice Architecture Based TB Preventive Therapy Prescribing), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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.

NCT04466293 nacompletednot on this map

Choice Architecture Based TB Preventive Therapy Prescribing: IMPAACT4TB Implementation Research

TypeinterventionalSponsorJohns Hopkins UniversityRan2021 to 2022Enrolled57ConditionsHIV/AIDS, TuberculosisArmsChoice Architecture
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Kate ShearerCenter for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA ksheare5@jhu.edu.ORCID http://orcid.org/0000-0003-2049-4258
Bareng A S NonyaneCenter for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA.ORCID http://orcid.org/0000-0001-5633-7487
Christiaan MulderTB Elimination and Health Systems Innovations, KNCV Tuberculosis Foundation, Den Haag, The Netherlands.
Emmanuel KaongaKNCV Tuberculosis Foundation, Lilongwe, Malawi.
Rose NyirendaDepartment of HIV and AIDS, Government of Malawi Ministry of Health, Lilongwe, Malawi.
Kuzani MbenderaNational Tuberculosis and Leprosy Elimination Program, Government of Malawi Ministry of Health, Lilongwe, Malawi.
Clara SambaniPublic Health Institute of Malawi, Government of Malawi Ministry of Health, Lilongwe, Malawi.
Emilio ValverdeFundação Aurum, Maputo, Mozambique.
Savaiva ManguambeFundação Aurum, Maputo, Mozambique.
Rogerio ChiauFundação Aurum, Maputo, Mozambique.
Nicole KawazaClinton Health Access Initiative, Harare, Zimbabwe.
Juliet JokwiroClinton Health Access Initiative, Harare, Zimbabwe.
Bongani DubeClinton Health Access Initiative, Harare, Zimbabwe.
Tsitsi ApolloZimbabwe Ministry of Health and Child Care, Harare, Zimbabwe.
Jeff WeiserThe Aurum Institute, Parktown, South Africa.
Violet ChihotaThe Aurum Institute, Parktown, South Africa.
Gavin J ChurchyardThe Aurum Institute, Parktown, South Africa.
Richard E ChaissonCenter for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA.
Jonathan E Golub *Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA.
Christopher J Hoffmann *Center for Tuberculosis Research, Johns Hopkins University, Baltimore, Maryland, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionWhile highly effective for reducing the risk of tuberculosis (TB) disease, TB preventive treatment (TPT) is underused among people living with HIV (PWH). We evaluated the effectiveness of a behavioural economics-based choice architecture approach to increase facility-level TPT prescribing to PWH in Malawi, Mozambique and Zimbabwe.

methodsWe conducted a cluster-randomised trial within the IMPAACT4TB 3HP rollout, in which 57 healthcare facilities were randomly assigned 1:1 to choice architecture (intervention) or standard TPT prescribing (control). The aim was to link TPT to antiretroviral therapy (ART) prescribing and to make TPT prescribing the default. The intervention was supported by clinician training and a default prescribing module built into the point-of-care HIV electronic medical record in Malawi and stickers placed in clients' clinical stationery in Mozambique and Zimbabwe. Data were collected in aggregate, and the primary outcome was the facility-level percentage of clients initiating ART who initiated TPT. The CAT study was registered with clinicaltrials.gov where it is listed as completed.

resultsImplementation occurred from October 2021 to September 2022 in Mozambique (20 facilities), April 2021 to March 2022 in Malawi (19 facilities) and June 2021 to May 2022 in Zimbabwe (18 facilities), for a total of 29 control arm and 28 choice architecture intervention arm facilities, respectively. Comparing control to intervention facilities, mean TPT prescribing to clients initiating ART was 70.9% vs 86.9% in Mozambique (difference: -16.0%; 95% CI: -38.3%, 6.3%; p=0.15), 56.5% vs 55.5% in Malawi (difference: 1.0%; 95% CI: -14.0%, 16.9%; p=0.89) and 56.2% vs 55.9% in Zimbabwe (difference: 0.2%; 95% CI: -25.2%, 25.8%; p=0.98).

conclusionThe choice architecture intervention did not overcome barriers to TPT prescribing. While the intervention may have led to an improvement in TPT prescribing in Mozambique, no differences were observed in the other countries. Further innovation is needed to ensure that all clients initiating ART are either prescribed TPT or started on anti-TB treatment, as appropriate. TRIAL REGISTRATION NUMBER: NCT04466293.

Indexed as

Antitubercular AgentsChoice BehaviorHIV InfectionsTuberculosisAdultAnti-HIV AgentsAnti-Retroviral AgentsFemaleHumansMalawiMaleMozambiqueZimbabweAnti-HIV AgentsAnti-Retroviral AgentsAntitubercular AgentsHIVTuberculosis

Identifiers

PMID40412816
PMCPMC12104925

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.