Table 4 Key findings and implications for practice change

CT awareness and familiarity

• Broader awareness of TB, treatment options and CT

• Information to be consistently talked about beyond the point of diagnosis

• Ongoing active community engagement activities

• Health promotion team participation in established community structures

• Information to be consistently talked about within policlinics

• Use of positive films

• Use of social media

• Community engagement to include spectrum from informing to collaborating [24, 25]

• 2-way peer approach to tackling issues raised on understanding and info circulation

Addressing fears and concerns

Information and support, e.g. to explain and reduce fears of CT as “experiment”, concerns about side effects

• Emphasise drug safety/approval, accountability, and mechanisms of responsibility, monitoring of side effects, etc.

• Build awareness of social responsibility—trial may contribute to improved treatment for community in future?

Discuss notion of “collateral damage” between practitioners and between practitioners and patients/peers

Randomisation process

• Explain purpose of randomisation

• Counter concerns that a computer is deciding on the fate of the patient, rather than a doctor

• Address concerns relating to fairness of randomisation

• Reassure that regimens are also recommended by doctors

• Build confidence of increased likelihood of a shorter regimen (not longer/worse than SoC)

• Explain fairness of randomisation process (addressing concerns around bribes)

Communicate and explain how the randomisation process works in an accessible way

Consent process

Simplifying consent process

• Present information through conversation, using aide-memoire

• Emphasise participant-led conversation

Prescriptive/formal questions are more likely to raise suspicion than understanding

Dual treatment approaches in one health system

Increasing MoH buy-in to expand access to eligible participants

Provide explanations for the different treatment approaches

• Explain the purpose and benefits of the CT

• Offer opportunities to tour site if appropriate, to foster understanding and acceptability

Involvement of community doctors/MoH

Increase familiarisation, support, and trust in the CT

Collaboration between family/community doctors, policlinic

Create opportunities to engage with community doctors and the MoH to discuss the CT

Trust in CT, belief that this is about a better treatment

• Expand value of peer support for CT engagement

• Build on achievement of the CT linked to positive values and quality of care

Enable potential CT patients to have access to CT wards rather than CC ward prior to initiating CT

Facilitate peer support to share experiential knowledge, quality of care and promote trust in new treatments

HCW confidence in CT

• Increase transparency around preliminary CT results

• Increase familiarisation and exposure to CT among MoH HCW

Meetings with HCWs to share updates about the CT

Communicate regularly with all HCWs about the CT and share results when possible