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Transcripts were thematically analysed to assess knowledge and attitudes towards TPT in rural South Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 22 senior nurses, 86% were female, with the median age of 39 years, and mean of 13.3 years\u2019 experience. Participants identified key individual-level barriers among nurses, interpersonal barriers that nurses observed among their patients and organisational barriers. While the nurses\u2019 belief in TPT efficacy was strong, their perceived barriers to TPT implementation included inflexible clinical guidelines, insufficient training and time to counsel patients, pill burden, patients\u2019 perceived HIV stigma and patients\u2019 alcohol use. Nurses believed implementation could be facilitated with task-shifting and integrating TPT into the antiretroviral (ART) infrastructure in primary care clinics and into chronic medication dispensing programmes. Shorter TPT regimens (eg, 12 weeks weekly INH\/rifapentine: 3HP) were considered advantageous.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nurses identified multiple barriers to TPT implementation, including insufficient training and time to counsel patients, pill burden, HIV stigma and alcohol use. Nurses suggested task-shifting, TPT\/ART integration and rollout of 3HP as potential facilitators of TPT implementation in rural South Africa. Nurses\u2019 perspectives are essential to informing TPT implementation efforts in resource-limited settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2024-002663","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T08:50:16Z","timestamp":1758876616000},"page":"e002663","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["\u2018And the stick to fight TB is TPT\u2019: nurse-identified barriers and facilitators of tuberculosis preventive therapy implementation in rural South Africa"],"prefix":"10.1136","volume":"12","author":[{"given":"Megan A","family":"Grammatico","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony P","family":"Moll","sequence":"additional","affiliation":[{"name":"Philanjalo NGO, Tugela Ferry, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amiya","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauretta E","family":"Grau","sequence":"additional","affiliation":[{"name":"Yale University School of Public Health, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sipho","family":"Nsele","sequence":"additional","affiliation":[{"name":"Philanjalo NGO, Tugela Ferry, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philile","family":"Makhunga","sequence":"additional","affiliation":[{"name":"Philanjalo NGO, Tugela Ferry, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Jones","sequence":"additional","affiliation":[{"name":"Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7654-4344","authenticated-orcid":false,"given":"Sheela V","family":"Shenoi","sequence":"additional","affiliation":[{"name":"Yale University School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"2026010701511417000_12.1.e002663.1","unstructured":"WHO . 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