Implementation strategies for integrating TB treatment into community pharmacies for people with TB/HIV in Uganda using human-centered design methodology

Background Community pharmacies (private retail drug shops/pharmacies) have emerged as a novel differentiated service delivery (DSD) model for delivering antiretroviral therapy (ART) to people with human immunodeficiency virus (HIV) and could support integrated tuberculosis (TB) medication refills. Using a Human-Centered Design (HCD) methodology, we developed an implementation strategy for integrating TB treatment into pharmacies targeting people with TB/HIV in Kampala, Uganda. Methods We implemented the inspiration and ideation phases of the HCD methodology. During the inspiration phase, we identified themes describing barriers and facilitators to integrating TB treatment into community pharmacies and conducted observations at community pharmacies to understand the care pathway of people with TB/HIV. We translated these qualitative findings into insight statements, design opportunities, and How Might We (HMW) questions. During the ideation phase, we conducted brainstorming and co-design workshops to generate and refine solutions, tested low-fidelity prototypes using ranked scores, and assessed the usability of high-fidelity prototypes using the System Usability Scale. Participants included people with TB/HIV, TB focal persons, HIV focal persons, Ministry of Health DSD model experts, and pharmacy healthcare providers. Results Of 26 low-fidelity prototypes, four implementation strategy components emerged: (1) raising awareness and building trust in pharmacy TB medication refills by TB and HIV focal persons, with a focus on privacy, convenience, and legitimacy; (2) standardizing TB medication refill workflows using synchronized ART/TB refill workflows, standardard operating procedures, and visual diagrams illustrating integration of TB treatment into community pharmacies; (3) strengthening the capacity of community pharmacies through certification, accreditation, and targeted TB training; and (4) strengthening monitoring and quality assurance through standard operating procedure manuals and standardized side-effect monitoring checklists. Conclusion The adapted strategy and high-fidelity prototypes will be evaluated in a pilot randomized trial assessing the effectiveness and implementation of TB treatment integration into pharmacies for people with TB/HIV in Kampala, Uganda.