A qualitative study of home- versus facility-based TB treatment for adolescents in Lima, Peru.

BACKGROUND: Prior to the COVID-19 pandemic, TB treatment in Peru was delivered almost exclusively through facility-based directly observed therapy (DOT). During the pandemic, selected adolescents were allowed home-based TB treatment under caregiver supervision, along with video-supported treatment (VST) for adolescents with access to a smartphone. METHODS: We conducted 16 focus groups, each with 4-10 participants of adolescents with rifampicin-susceptible TB, their caregivers, and health care workers (HCWs). We used semi-structured guides to gather perspectives on facility-based DOT versus home-based treatment. Two authors applied inductive thematic analysis and identified emerging themes. RESULTS: HCWs assigned facility-based DOT or home-based treatment based on subjective assessment of the adolescent's level of responsibility and support from caregivers. Almost all adolescents and caregivers preferred home-based treatment because it reduced disruptions to routine activities, TB-related stigma, and costs. A few disagreed, stating that facility-based DOT was better for guaranteeing adherence and support for adverse drug reactions. Most HCWs preferred facility-based DOT because they did not feel confident about adherence without direct visualisation by a provider, even with VST; moreover, they found VST to be time-consuming. CONCLUSION: Home-based TB treatment benefits adolescents and caregivers but must be further modified to achieve feasibility and acceptability among HCWs.