ArticlemedRxiv : the preprint server for health sciences2026
Concerns, Priorities, and Pathways: Healthcare Provider Perspectives on Implementing Tuberculosis Preventive Treatment for People with HIV in Indonesia and the Philippines.
Article in medRxiv : the preprint server for health sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Tuberculosis preventive therapy (TPT) is a cornerstone intervention for reducing TB incidence among people living with HIV, yet its integration into routine care remains inconsistent in high-burden settings. While policy frameworks are well established, less is known about how frontline healthcare workers (HCWs) operationalize TPT within constraint health systems. Thisstudy explores healthcare workers' (HCWs) perspectives on TPT implementation in Indonesia and the Philippines using normalization process theory (NPT), to understand how TPT is (or fails to be) embedded in everyday clinical practice. Methods: Weconducted ten focus group discussions and four in-depth interviews with HCWs across major TB/HIV treatment centers in Manila, Philippines and Jakarta, Indonesiabetween June to December 2023. Data were analyzed using reflexive thematic analysis, followed by interpretative mappingontofour NPT constructs: coherence, cognitive participation, collective action and reflexive monitoring. Results: TPT implementation was characterized by a persistent gap between policy intent and routine practice. Under Conclusions: TPT implementation is not limited by awareness alone but by the absence of routinized systems that support consistent practice. Strengthening implementation requires shifting from individual-dependent delivery toward system-enabled integration, through standardized protocols, distributed workforce engagement, embedded monitoring mechanisms, and uninterrupted drug supply systems. Interventions that align with everyday clinical workflows and reinforce collective responsibility across cadres are critical to closing policy and practice gap.
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