Stakeholder perspectives and preferences for long-acting injectables for tuberculosis treatment and prevention: a multi-regional mixed-methods study

Objective: To assess stakeholder acceptability of and preferences for long-acting injectables (LAIs) for tuberculosis (TB) treatment and prevention across World Health Organization regions to inform product development and implementation. Methods: We conducted a sequential explanatory mixed-methods study of survey data and qualitative focus group discussions (FGDs). Online surveys assessed perceptions and acceptance of LAIs among two groups: TB programme managers, civil society members and healthcare workers (Survey A), and community members and persons affected by TB (Survey B). Using purposive sampling, survey participants were invited to join FGDs to explore survey findings. Survey data were analysed using descriptive statistics, ordinal logistic regression with stepwise AIC selection, and one-sample proportion tests. FGD transcripts were analysed using modified framework analysis. Findings: Among 310 participants (102 Survey A; 208 Survey B), 83% (n=256) favoured LAIs over standard oral TB treatment. Compared with six months of daily oral treatment, 69% preferred a three-month regimen comprising one month of daily oral treatment followed by four injections per monthly visit for two months, while 80% preferred the corresponding regimen with two injections per visit. For prevention, 79% preferred a single injection over one month of oral treatment. In Survey B, interest varied according to lived TB experience, with FGDs suggesting that previous negative experiences with injectables may have contributed to this variation. Conclusion: Interest in LAIs for TB treatment and prevention was high, but lower among participants with lived TB experience. Product development and implementation should address concerns about injectables and side effects while preserving patient choice and agency.