Effectiveness of Multi-Month Dispensing of Anti-Tuberculosis Drugs

Policy Context

Although tuberculosis (TB) is treatable and curable with a standard six-month regimen, the disease remains a public health problem in low-and middle -income countries due to physical and economic barriers to care. Large distances to treatment, in addition to frequent clinic visits, contribute to suboptimal treatment adherence and outcomes. To improve access to TB treatment, researchers propose multi-month dispensing of anti-TB drugs (MULTI-DAT) to cover more than two months of treatment, reducing the need for frequent health facility visits. Multi-month dispensing is already recommended by the Uganda Ministry of Health for people living with HIV, provided one is stable on antiretroviral therapy medications.

This study will explore stakeholder perceptions regarding the relevance and appropriateness of MULTI-DAT, including the delivery of MULTI-DAT among people with drug-susceptible pulmonary TB. The study also seeks to evaluate the effectiveness of MULTI-DAT on the cure and treatment success rate at six months of treatment, compared to the standard of care.

Study Design

To explore stakeholder perceptions regarding the relevance and appropriateness of MULTI-DAT, including the needed modifications before and during implementation, the research team will conduct a formative qualitative study with more than eighty stakeholders in TB care at the national, sub-national, district, and health facility levels. This will include people with TB, as well as their treatment supporters.

Based on qualitative findings, researchers will refine the MULTI-DAT approach and then conduct

an open-label, individually randomized evaluation to determine the effectiveness of MULTI-DAT versus the standard of care on rates of cure and treatment success.

Results and Policy Lessons

Evidence from this study will inform the modification of the national TB treatment guideline and will support the national scale-up of MULTI-DAT through the National TB and Leprosy Control Program (NTLP), Ministry of Health (MoH), Uganda. Results forthcoming.