Acceptability, feasibility, and likelihood of stakeholders implementing the novel BPaL regimen to treat extensively drug-resistant tuberculosis patients

S.E.J. van de Berg, P.T. Pelzer, A.J. van der Land, E. Abdrakhmanova, A. Muhammad Ozi, M. Arias, S. Cook-Scalise, G. Dravniece, A. Gebhard, S. Juneja, R. Handayani, D. Kappel, M. Kimerling, I. Koppelaar, S. Malhotra, B. Myrzaliev, B. Nsa, J. Sugiharto, N. Engel, C. MulderS. van den Hof

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Background: BPaL, a 6 month oral regimen composed of bedaquiline, pretomanid, and linezolid for treating extensively drug-resistant tuberculosis (XDR-TB) is a potential alternative for at least 20 months of individualized treatment regimens (ITR). The ITR has low tolerability, treatment adherence, and success rates, and hence to limit patient burden, loss to follow-up and the emergence of resistance it is essential to implement new DR-TB regimens. The objective of this study was to assess the acceptability, feasibility, and likelihood of implementing BPaL in Indonesia, Kyrgyzstan, and Nigeria. Methods: We conducted a concurrent mixed-methods study among a cross-section of health care workers, programmatic and laboratory stakeholders between May 2018 and May 2019. We conducted semi-structured interviews and focus group discussions to assess perceptions on acceptability and feasibility of implementing BPaL. We determined the proportions of a recoded 3-point Likert scale (acceptable; neutral; unacceptable), as well as the overall likelihood of implementing BPaL (likely; neutral; unlikely) that participants graded per regimen, pre-defined aspect and country. We analysed the qualitative results using a deductive framework analysis. Results: In total 188 stakeholders participated in this study: 63 from Kyrgyzstan, 51 from Indonesia, and 74 from Nigeria The majority were health care workers (110). Overall, 88% (146/166) of the stakeholders would likely implement BPaL once available. Overall acceptability for BPaL was high, especially patient friendliness was often rated as acceptable (93%, 124/133). In contrast, patient friendliness of the ITR was rated as acceptable by 45%. Stakeholders appreciated that BPaL would reduce workload and financial burden on the health care system. However, several stakeholders expressed concerns regarding BPaL safety (monitoring), long-term efficacy, and national regulatory requirements regarding introduction of the regimen. Stakeholders stressed the importance of addressing current health systems constraints as well, especially in treatment and safety monitoring systems. Conclusions: Acceptability and feasibility of the BPaL regimen is high among TB stakeholders in Indonesia, Kyrgyzstan, and Nigeria. The majority is willing to start using BPaL as the standard of care for eligible patients despite country-specific health system constraints.
Original languageEnglish
Article number1404
JournalBMC Public Health
Volume21
Issue number1
DOIs
Publication statusPublished - 1 Dec 2021
Externally publishedYes

Funding

This study was funded by TB Alliance. The funder reviewed the research methodology and the report template and this manuscript but was not involved directly in the analysis of the results. We would like to thank all stakeholders in Indonesia, Kyrgyzstan, and Nigeria for their facilitation and their participation in individual interviews and focus group discussions, sharing their invaluable experiences and insights. We would especially like to acknowledge the work of the local PMDT-consultants Fenni Fenni (Indonesia), Nazgul Aidrelieva (Kyrgyzstan) and Valerie Obot (Nigeria) and the teams that supported them. In Indonesia, this was John Sugiharto and the Yayasan KNCV Indonesia team (Fadhil Ali, Ancilla Illinantyas). In Kyrgyzstan this was Emir Dzhumaliev, Totugul Murzabekova, Bakyt Myrzaliev, Nazira Sarpashova and Gulzat Sultanidinova; in Nigeria: Unyime Akpan, Tari Horsfall, Bassey Nsa, Odage Oyama, Useni Sani and Irene Udo. Special thanks to the NTP managers Adebola Lawanson (Nigeria), Bolotbek Maykanaev (Kyrgyzstan) and Imran Pambudi (Indonesia) and former the Kyrgyz NTP manager Abdylat Kadyrov for support to the team to realize this work. We would like to thank Julia Morber for assisting with data entry. Finally, we want to thank Ineke Spruijt for her continued support and extensive review.

FundersFunder number
Bakyt Myrzaliev
Bolotbek Maykanaev
Imran Pambudi
NTP managers Adebola Lawanson
Nazgul Aidrelieva
Nazira Sarpashova and Gulzat Sultanidinova
TB Alliance

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