{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T03:15:42Z","timestamp":1790565342003,"version":"4.1.0"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"Fogarty International Center of the National Institutes of Health","award":["K43TW012839"],"award-info":[{"award-number":["K43TW012839"]}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Community pharmacies (private retail drug shops or pharmacies) have proven successful for delivering anti-retroviral therapy to people living with human immunodeficiency virus (HIV). Leveraging this model for tuberculosis (TB) treatment integration could improve access to both TB and HIV treatment among people with TB\/HIV. We identified the barriers and facilitators to integrating TB treatment into community pharmacies for people with TB\/HIV in Kampala, Uganda, using a qualitative study across six public health facilities. Participants included people with TB\/HIV; healthcare providers (HCPs) from the six facilities and their affiliated community pharmacies; and experts from the Ministry of Health. Data were collected through interviews guided by the Consolidated Framework for Implementation Research (CFIR). We performed framework analysis and mapped the emergent sub-themes to the relevant CFIR domains. We enrolled 47 participants: six TB focal persons, six HIV focal persons, nine pharmacy HCPs, three Ministry of Health staff, and 23 people with TB\/HIV. Major facilitators included the convenience of accessing both TB and HIV treatment at a single location; enhanced privacy and reduced stigma; improved accessibility through extended hours, shorter wait times, and proximity; readiness of community pharmacy HCPs to deliver TB treatment; willingness of people with TB\/HIV to engage in self-managed care; and training of pharmacy HCPs in TB care. Key barriers included unclear eligibility criteria for enrolling people with TB\/HIV, absence of TB counseling services at pharmacies, inadequate infrastructure for TB drug storage, limited confidence among pharmacy HCPs in delivering TB care, and unclear logistics and operational procedures for implementation. Therefore, context-specific interventions that are developed in collaboration with key stakeholders, address barriers like eligibility criteria refinement, enhanced pharmacy HCP training, and financial incentives, and leverage facilitators like policy support and stakeholder readiness, are needed for the successful integration of TB treatment into community pharmacies for people with TB\/HIV in Uganda.<\/jats:p>","DOI":"10.1371\/journal.pgph.0004951","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T18:39:23Z","timestamp":1763750363000},"page":"e0004951","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Barriers and facilitators to integrating tuberculosis treatment into community pharmacies for people with TB\/HIV in Kampala, Uganda: A qualitative study"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9065-0389","authenticated-orcid":true,"given":"Jonathan","family":"Izudi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adithya","family":"Cattamanchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Sekaggya-Wiltshire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah","family":"Kiwanuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8044-7165","authenticated-orcid":true,"given":"Amanda","family":"Sammann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0085-3498","authenticated-orcid":true,"given":"Rachel","family":"King","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"issue":"3","key":"pgph.0004951.ref001","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.26439","article-title":"Addressing post-tuberculosis sequelae among people living with HIV: an unmet need","volume":"28","author":"V Mave","year":"2025","journal-title":"J Int AIDS Soc"},{"issue":"7","key":"pgph.0004951.ref002","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.arbres.2019.11.015","article-title":"Tuberculosis-HIV Co-Infection: Progress and Challenges After Two Decades of Global Antiretroviral Treatment Roll-Out","volume":"56","author":"E Letang","year":"2020","journal-title":"Arch Bronconeumol"},{"key":"pgph.0004951.ref003","first-page":"19","volume-title":"Global tuberculosis report 2023. Global tuberculosis report 2023","author":"World Health Organization","year":"2023"},{"issue":"1","key":"pgph.0004951.ref004","doi-asserted-by":"crossref","DOI":"10.1016\/S2666-5247(22)00359-7","article-title":"WHO\u2019s Global Tuberculosis Report 2022","volume":"4","author":"S Bagcchi","year":"2023","journal-title":"Lancet Microbe"},{"issue":"9","key":"pgph.0004951.ref005","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-029400","article-title":"Treatment success rate among adult pulmonary tuberculosis patients in sub-Saharan Africa: a systematic review and meta-analysis","volume":"9","author":"J Izudi","year":"2019","journal-title":"BMJ Open"},{"key":"pgph.0004951.ref006","doi-asserted-by":"crossref","first-page":"8298291","DOI":"10.1155\/2020\/8298291","article-title":"Tuberculosis Chemotherapy Outcome in the Littoral Region of Cameroon: A Meta-analysis of Treatment Success Rate between 2014 and 2016","volume":"2020","author":"DF Kouemo Motse","year":"2020","journal-title":"Biomed Res Int"},{"issue":"12","key":"pgph.0004951.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0226507","article-title":"Factors predictive of the success of tuberculosis treatment: A systematic review with meta-analysis","volume":"14","author":"NM Chaves Torres","year":"2019","journal-title":"PLoS One"},{"issue":"20","key":"pgph.0004951.ref008","doi-asserted-by":"crossref","first-page":"10678","DOI":"10.3390\/ijerph182010678","article-title":"Tuberculosis Treatment Outcome and Predictors in Africa: A Systematic Review and Meta-Analysis","volume":"18","author":"MY Teferi","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pgph.0004951.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0082235","article-title":"Association between HIV\/AIDS and multi-drug resistance tuberculosis: a systematic review and meta-analysis","volume":"9","author":"YM Mesfin","year":"2014","journal-title":"PLoS One"},{"key":"pgph.0004951.ref010","volume-title":"National Strategic Plan For Tuberculosis and Leprosy Control 2020\/21\u2013 024\/25","author":"Republic of Uganda","year":"2020"},{"issue":"7","key":"pgph.0004951.ref011","doi-asserted-by":"crossref","DOI":"10.1101\/cshperspect.a017871","article-title":"Tuberculosis and HIV Coinfection","volume":"5","author":"J Bruchfeld","year":"2015","journal-title":"Cold Spring Harb Perspect Med"},{"key":"pgph.0004951.ref012","doi-asserted-by":"crossref","first-page":"100461","DOI":"10.1016\/j.ijregi.2024.100461","article-title":"Effect of missed clinic visits on treatment outcomes among people with tuberculosis: a quasi-experimental study utilizing instrumental variable analysis","volume":"13","author":"J Izudi","year":"2024","journal-title":"IJID Reg"},{"issue":"1","key":"pgph.0004951.ref013","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1186\/s12874-025-02553-x","article-title":"Causal inference methodologies to assess the effect of missed clinic visits on treatment success rate among people with tuberculosis in rural Uganda","volume":"25","author":"J Izudi","year":"2025","journal-title":"BMC Med Res Methodol"},{"key":"pgph.0004951.ref014","doi-asserted-by":"crossref","first-page":"100226","DOI":"10.1016\/j.jctube.2021.100226","article-title":"HIV infection modifies the relationship between distance to a health facility and treatment success rate for tuberculosis in rural eastern Uganda","volume":"23","author":"B Olupot","year":"2021","journal-title":"J Clin Tuberc Other Mycobact Dis"},{"issue":"1","key":"pgph.0004951.ref015","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1186\/s12879-020-05099-z","article-title":"Is distance associated with tuberculosis treatment outcomes? A retrospective cohort study in Kampala, Uganda","volume":"20","author":"KO Robsky","year":"2020","journal-title":"BMC Infect Dis"},{"key":"pgph.0004951.ref016","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijid.2022.03.011","article-title":"The WHO Global Tuberculosis 2021 Report - not so good news and turning the tide back to End TB","volume":"124","author":"J Chakaya","year":"2022","journal-title":"Int J Infect Dis"},{"key":"pgph.0004951.ref017","article-title":"Tuberculosis treatment within differentiated service delivery models in global HIV\/TB programming","volume":"24","author":"CH Tran","year":"2021","journal-title":"J Int AIDS Soc"},{"key":"pgph.0004951.ref018","volume-title":"Consolidated guidelines for the prevention and treatment of HIV and AIDS in Uganda","author":"Republic of Uganda","year":"2020"},{"issue":"5","key":"pgph.0004951.ref019","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0269020","article-title":"Client and healthcare worker experiences with differentiated HIV treatment models in Eswatini","volume":"17","author":"W Reidy","year":"2022","journal-title":"PLoS One"},{"issue":"10","key":"pgph.0004951.ref020","article-title":"The effectiveness, feasibility and acceptability of HIV service delivery at private pharmacies in sub-Saharan Africa: a scoping review","volume":"25","author":"AP Kuo","year":"2022","journal-title":"J Int AIDS Soc"},{"key":"pgph.0004951.ref021","first-page":"539","article-title":"Experiences and Perceptions on Community Client-Led ART Delivery (CCLADS) Model of Antiretroviral (ART) Delivery: Patients\u2019 and Providers\u2019 Perspectives in South Western Uganda","volume":"14","author":"M Kasande","year":"2022","journal-title":"HIV AIDS (Auckl)"},{"issue":"1","key":"pgph.0004951.ref022","doi-asserted-by":"crossref","first-page":"4","DOI":"10.5588\/pha.22.0047","article-title":"Increase in rifampicin resistance among people previously treated for TB","volume":"13","author":"J Izudi","year":"2023","journal-title":"Public Health Action"},{"issue":"8","key":"pgph.0004951.ref023","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0002240","article-title":"Impact of intensive adherence counseling on viral load suppression and mortality among people living with HIV in Kampala, Uganda: A regression discontinuity design","volume":"3","author":"J Izudi","year":"2023","journal-title":"PLOS Glob Public Health"},{"key":"pgph.0004951.ref024","doi-asserted-by":"crossref","first-page":"116595","DOI":"10.1016\/j.socscimed.2024.116595","article-title":"Barriers and facilitators to viral load suppression among people living with HIV following intensive adherence counseling in Kampala, Uganda: A qualitative study","volume":"343","author":"J Izudi","year":"2024","journal-title":"Soc Sci Med"},{"issue":"1","key":"pgph.0004951.ref025","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated Consolidated Framework for Implementation Research based on user feedback","volume":"17","author":"LJ Damschroder","year":"2022","journal-title":"Implement Sci"},{"issue":"4","key":"pgph.0004951.ref026","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1007\/s11135-017-0574-8","article-title":"Saturation in qualitative research: exploring its conceptualization and operationalization","volume":"52","author":"B Saunders","year":"2018","journal-title":"Qual Quant"},{"issue":"5","key":"pgph.0004951.ref027","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0232076","article-title":"A simple method to assess and report thematic saturation in qualitative research","volume":"15","author":"G Guest","year":"2020","journal-title":"PLoS One"},{"issue":"6","key":"pgph.0004951.ref028","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"A Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"issue":"9","key":"pgph.0004951.ref029","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.5588\/ijtld.14.0020","article-title":"Understanding private retail drug outlet dispenser knowledge and practices in tuberculosis care in Tanzania","volume":"18","author":"E Rutta","year":"2014","journal-title":"Int J Tuberc Lung Dis"},{"issue":"8","key":"pgph.0004951.ref030","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.arbr.2016.06.013","article-title":"The Role of Community Pharmacies in the Treatment of Tuberculosis","volume":"52","author":"F Sanz Herrero","year":"2016","journal-title":"Arch Bronconeumol (English Edition)"},{"issue":"4","key":"pgph.0004951.ref031","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.4314\/ahs.v21i4.18","article-title":"Stigma among tuberculosis patients and associated factors in urban slum populations in Uganda","volume":"21","author":"C Ashaba","year":"2021","journal-title":"Afr Health Sci"},{"issue":"1","key":"pgph.0004951.ref032","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0313750","article-title":"Level of tuberculosis-related stigma and associated factors in Ugandan communities","volume":"20","author":"D Kimuli","year":"2025","journal-title":"PLoS One"},{"issue":"4","key":"pgph.0004951.ref033","first-page":"508","article-title":"Active case finding of undetected tuberculosis among chronic coughers in a slum setting in Kampala, Uganda","volume":"13","author":"JN Sekandi","year":"2009","journal-title":"Int J Tuberc Lung Dis"},{"issue":"1","key":"pgph.0004951.ref034","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1186\/s12913-021-07105-9","article-title":"Exploring drivers and barriers to the utilization of community client-led ART delivery model in South-Western Uganda: patients\u2019 and health workers\u2019 experiences","volume":"21","author":"TM Kintu","year":"2021","journal-title":"BMC Health Serv Res"},{"issue":"7","key":"pgph.0004951.ref035","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0254214","article-title":"A mixed-methods evaluation of the uptake of novel differentiated ART delivery models in a national sample of health facilities in Uganda","volume":"16","author":"H Zakumumpa","year":"2021","journal-title":"PLoS One"},{"issue":"1","key":"pgph.0004951.ref036","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1186\/s12913-020-5069-y","article-title":"Understanding implementation barriers in the national scale-up of differentiated ART delivery in Uganda","volume":"20","author":"H Zakumumpa","year":"2020","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pgph.0004951.ref037","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1186\/s12913-022-08825-2","article-title":"Barriers and facilitators to the implementation and scale up of differentiated service delivery models for HIV treatment in Africa: a scoping review","volume":"22","author":"YA Belay","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"pgph.0004951.ref038","article-title":"Engaging community pharmacists in tuberculosis-directly observed treatment: a mixed-methods study","volume":"24","author":"YJ Wong","year":"2023","journal-title":"Prim Health Care Res Dev"},{"issue":"4","key":"pgph.0004951.ref039","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2022-008661","article-title":"Engaging pharmacies in tuberculosis control: operational lessons from 19 case detection interventions in high-burden countries","volume":"7","author":"J Bigio","year":"2022","journal-title":"BMJ Glob Health"},{"issue":"7","key":"pgph.0004951.ref040","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0196648","article-title":"Knowledge, attitudes and practices related to tuberculosis in pharmacy workers in a cross-sectional survey in El Agustino, Peru","volume":"13","author":"PJ Garc\u00eda","year":"2018","journal-title":"PLoS One"},{"issue":"4","key":"pgph.0004951.ref041","doi-asserted-by":"crossref","first-page":"526","DOI":"10.4103\/ijph.ijph_231_23","article-title":"Willingness for Active Case Finding of Tuberculosis among Community Pharmacists in Puducherry","volume":"68","author":"D Govindan","year":"2024","journal-title":"Indian J Public Health"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0004951","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T18:39:29Z","timestamp":1763750369000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0004951"}},"subtitle":[],"editor":[{"given":"Henry","family":"Zakumumpa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,11,21]]},"references-count":41,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0004951","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,21]]}}}