Implementation strategies for integrating TB treatment into community pharmacies for people with TB/HIV in Uganda using human-centered design methodology
Using a Human-Centered Design methodology in Kampala, Uganda, researchers developed and refined a four-component implementation strategy to integrate tuberculosis treatment into community pharmacies for people with TB/HIV, focusing on trust-building, standardized workflows, capacity strengthening, and quality assurance for future pilot evaluation.
Original paper dedicated to the public domain under CC0 1.0 (https://creativecommons.org/publicdomain/zero/1.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
In many parts of the world where tuberculosis and HIV are common, the journey to stay healthy is often a long and difficult one. Patients must travel to crowded clinics, wait for hours, and navigate complex systems just to pick up their medicine. For those living with both diseases, the burden is even heavier, and missing doses can have serious consequences. To solve this, health systems are looking for ways to bring care closer to where people live and work. One promising idea is to let community pharmacies, the local drug stores found in neighborhoods, handle the routine refills of life-saving medication. This approach, known as differentiated service delivery, aims to reduce travel time, lower the risk of being seen at a clinic where one's status might be guessed, and free up doctors to focus on the most critical cases. While this model has worked well for HIV treatment in some places, bringing tuberculosis care into these same local shops has been a challenge, largely because the two diseases require different management protocols and the local pharmacists need clear guidance and support to handle them safely.
Researchers in Uganda set out to solve this puzzle by designing a new way to integrate tuberculosis treatment into community pharmacies, but they did not just guess what would work. Instead, they used a method called human-centered design, which treats the people who will use the system as the experts in creating it. The team gathered a diverse group of stakeholders, including people living with both tuberculosis and HIV, the doctors and nurses who manage their care, and the pharmacists who would dispense the medicine. Over the course of two days, these groups sat together to map out the problems, share their fears and hopes, and brainstorm solutions. They looked at the entire journey a patient takes, from the moment they leave the clinic to the moment they pick up their pills at a local shop, identifying exactly where the process breaks down. The group discovered that while people were willing to try this new system, they were held back by a lack of trust, confusion about how it would work, and concerns that the local pharmacists were not trained or equipped to handle tuberculosis medications safely.
From these conversations, the researchers and participants co-created a set of practical tools and rules to make the system work. They developed four main strategies to guide the integration. First, they decided that trusted health workers, specifically the staff members who manage tuberculosis and HIV care at the clinics, must personally introduce patients to the pharmacy option. These workers would explain the benefits of picking up medicine locally, emphasizing that it is safe, private, and convenient, to build confidence before the patient ever steps into a shop. Second, the team created clear, step-by-step instructions and visual diagrams to show pharmacists exactly how to dispense both tuberculosis and HIV medicines at the same time. This includes a plan for giving patients several months' worth of medication in one visit, which reduces the number of trips they need to make. Third, they established a system to train and certify the pharmacies, ensuring that only those with the right storage conditions and trained staff are allowed to participate. Finally, they designed simple checklists for pharmacists to use every time they hand over medicine, helping them spot any side effects early and ensuring the quality of care remains high.
To test these ideas, the researchers built detailed models of their new system and asked the participants to rate them on how easy they were to use and how likely they were to succeed. The feedback was overwhelmingly positive. The participants gave the new checklists and workflow diagrams very high marks for usability, indicating that the tools were clear and practical. The group agreed that having a standardized way to monitor patients and a clear path for dispensing medicine would make the system reliable. The researchers concluded that this person-centered approach successfully turned a complex health challenge into a manageable plan. They are now preparing to test this specific set of strategies in a real-world trial in Kampala, Uganda, to see if it can truly improve health outcomes for people living with both diseases. The work demonstrates that when patients and providers are invited to design the solution together, the result is a system that is not only scientifically sound but also deeply trusted by the community it serves.
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