# Choice-architecture TB preventive therapy prescribing for HIV patients in Mozambique

## TL;DR

This study tested a choice-architecture intervention to improve TB preventive therapy prescribing for HIV patients in Mozambique, finding it acceptable and feasible for healthcare workers.

## Contribution

The study introduces a choice-architecture-based intervention to streamline TB preventive therapy prescribing for HIV patients in low-resource settings.

## Key findings

- The intervention was viewed positively by healthcare workers and streamlined patient management.
- Participants reported no significant changes to routine TPT prescribing but emphasized the need for reminders and decision-support tools.
- The strategy could integrate TB prevention into broader HIV care and other preventive services.

## Abstract

Despite the effectiveness of TB preventive treatment (TPT) in reducing TB incidence and mortality among people living with HIV (PLHIV), uptake has been low. We conducted a cluster randomised trial to evaluate a choice architecture-based intervention for prescribing TPT (the ‘CAT’ study) to PLHIV in Mozambique, nested within the short-course 3HP regimen roll-out, and qualitatively assessed intervention acceptability and feasibility with healthcare workers (HCWs).

The CAT intervention comprised training on default TPT prescribing and prescribing stickers integrated into antiretroviral therapy (ART) stationery. We assessed intervention acceptability and feasibility to increase TPT prescribing through 25 in-depth interviews (IDIs) with HCWs from participating clinics between August and September 2022. Thematic analysis of the IDIs identified key themes.

Participants reported a positive impact of the intervention on patient care, though workload opinions varied. Participants reported that CAT did not significantly alter routine TPT prescribing processes but highlighted the need for reminders and decision-support tools. CAT was viewed to streamline patient management, particularly identifying eligible TPT patients and simplifying documentation.

The CAT strategy could enhance TPT delivery to PLHIV and integrate it into preventive care for other diseases.