Integrating tuberculosis treatment into community pharmacies to improve TB/HIV outcomes in Uganda.

PROJECT SUMMARY/ABSTRACT The overall objective of this K43 Emerging Global Leader Award is to support Dr. Jonathan Izudi’s transition to independence as an implementation scientist focused on improving tuberculosis (TB)/HIV care. Dr. Izudi's long- term goal is to reduce the TB burden among people living with HIV (PLHIV) by tackling barriers to successful

prevention, diagnosis, and treatment using context-relevant interventions delivered through person-centered strategies. The overall objective of this K43 grant application is to develop and pilot an implementation strategy focused on integrating TB treatment into community pharmacies among people with TB/HIV in Uganda. People

with TB/HIV have sub-optimal treatment outcomes, with the pooled treatment success rate averaging 70-71%, far below the World Health Organization's desired target of ≥90%. Compared to people who do not have HIV, treatment success is 35-47% lower and the risk of developing multi-drug resistant TB is 24% higher. Community

pharmacies are a proven differentiated antiretroviral therapy (ART) service delivery model that has been successful in moving ART from central health facilities to the community. In doing so, ART access, coverage, and adherence are improved because medication pick-ups are more convenient, inadvertent HIV status

disclosure and community stigma are prevented, and health workers can focus on people with adherence challenges. Community pharmacies present a potential to provide similar benefits to people with TB/HIV through offering TB medication refills. Dr. Izudi hypothesizes that a theory-informed, context-relevant strategy for

integrating TB treatment into community pharmacies adapted to the needs of people with TB/HIV and health workers will improve TB treatment success. To test the central hypothesis, Dr. Izudi proposed three specific aims: Aim 1) to explore the barriers and facilitators to integrating TB treatment into community pharmacies

among people with TB/HIV; Aim 2) to adapt a person-centered strategy for integrating TB treatment into community pharmacies using human-centered design methodology; and, Aim 3) to evaluate the implementation outcomes (feasibility, fidelity, and acceptability) and preliminary effectiveness of integrating TB treatment into

community pharmacies among people with TB/HIV. Completion of the aims will provide the preliminary data to support Dr. Izudi's application for an R01 proposing a cluster-randomized trial to evaluate the implementation and effectiveness of integrating TB treatment into community pharmacies at the national level. In addition,

conducting the proposed studies will enable Dr. Izudi to achieve four training goals: 1) To acquire advanced skills in qualitative and mixed methods research; 2) To gain skills and competence in implementation science research enabling the sound use of theories, models, and frameworks; 3) To gain expertise in interventional studies in

implementation science research; and 4) To gain expertise in grantsmanship for transition to a successful research career. The proposed studies will enable Dr. Izudi to complement his skillset in public health and epidemiology with advanced skills in socio-behavioral research, implementation science, and interventional

studies through specific training and tailored mentorship.