Children, caregivers and health workers’ perceptions and experiences of the XTEMP-R tool to improve tuberculosis treatment

Treating drug-resistant tuberculosis (DR-TB) in children remains a significant challenge for patients, caregivers, and health systems, despite advances in child-friendly drug formulations. While new formulations offer benefits, their widespread availability is limited, and many exhibit poor palatability. A key strategy to improve administration and mask the taste of paediatric TB medications involves creating extemporaneous suspensions. However, this often requires pharmaceutical services not readily available in high-burden settings. To address this, the Global Alliance for TB Drug Development (TB Alliance) developed XTEMP-R, an inexpensive prototype tool designed to facilitate home-based preparation of liquid TB medication suspensions. This study explored the experiences and perceptions of children, their caregivers, and health workers regarding the XTEMP-R tool for preparing extemporaneous DR-TB treatment suspensions. We collected qualitative data from two sites in South Africa. The first component involved interviews with 17 caregivers and 12 health workers, followed by focus group discussions, with participants directly interacting with the XTEMP-R tool. The second component comprised 31 interviews with 11 caregivers of 13 children who used the XTEMP-R tool for home administration. Case descriptions were iteratively refined and analyzed using deductive thematic analysis. Findings indicate that children, caregivers, and health workers found the XTEMP-R tool easy to use, clean, and store, appreciating its appealing color and durability. Home users reported that the tool simplified treatment preparation and administration, reducing time and relational burdens associated with DR-TB treatment. While XTEMP-R effectively addressed usability challenges related to drug preparation, fundamental obstacles concerning medication palatability, nausea, and side effects remain significant barriers. Importantly, the tool appeared to foster increased treatment responsibility among some children, suggesting a potential pathway to improve therapeutic engagement and agency. This research underscores the XTEMP-R tool's potential to ease paediatric DR-TB treatment and highlights crucial areas for design refinement, ultimately aiming to enhance adherence and overall outcomes.