Acceptability, feasibility, and likelihood of stakeholders implementing the novel BPaL regimen to treat extensively drug-resistant tuberculosis patients

van de Berg S.E.J., Pelzer P.T., van der Land A.J., Abdrakhmanova E., Ozi A.M., Arias M., Cook-Scalise S., Dravniece G., Gebhard A., Juneja S., Handayani R., Kappel D., Kimerling M., Koppelaar I., Malhotra S., Myrzaliev B., Nsa B., Sugiharto J., Engel N., Mulder C., van den Hof S.

KNCV Tuberculosis foundation, The Hague, Netherlands; National TB Program Kyrgyzstan, Bishkek, Kyrgyzstan; National Tuberculosis and Leprosy control Program Nigeria, Mabushi, Nigeria; TB AllianceNY, United States; PATH, Kyiv, Ukraine; National TB Program Indonesia, Jakarta, Indonesia; KNCV country office Kyrgyzstan, Bishkek, Kyrgyzstan; KNCV country office Nigeria, Abuja, Nigeria; Yayasan KNCV Indonesia, Jakarta, Indonesia; Maastricht University, Maastricht, Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam University Medical Center, Amsterdam, Netherlands; National Institute for Public Health and the Environment, Bilthoven, Netherlands


Background: BPaL, a 6 month oral regimen composed of bedaquiline, pretomanid, and linezolid for treating extensively drug-resistant tuberculosis (XDR-TB) is a potential alternative for at least 20 months of individualized treatment regimens (ITR). The ITR has low tolerability, treatment adherence, and success rates, and hence to limit patient burden, loss to follow-up and the emergence of resistance it is essential to implement new DR-TB regimens. The objective of this study was to assess the acceptability, feasibility, and likelihood of implementing BPaL in Indonesia, Kyrgyzstan, and Nigeria. Methods: We conducted a concurrent mixed-methods study among a cross-section of health care workers, programmatic and laboratory stakeholders between May 2018 and May 2019. We conducted semi-structured interviews and focus group discussions to assess perceptions on acceptability and feasibility of implementing BPaL. We determined the proportions of a recoded 3-point Likert scale (acceptable; neutral; unacceptable), as well as the overall likelihood of implementing BPaL (likely; neutral; unlikely) that participants graded per regimen, pre-defined aspect and country. We analysed the qualitative results using a deductive framework analysis. Results: In total 188 stakeholders participated in this study: 63 from Kyrgyzstan, 51 from Indonesia, and 74 from Nigeria The majority were health care workers (110). Overall, 88% (146/166) of the stakeholders would likely implement BPaL once available. Overall acceptability for BPaL was high, especially patient friendliness was often rated as acceptable (93%, 124/133). In contrast, patient friendliness of the ITR was rated as acceptable by 45%. Stakeholders appreciated that BPaL would reduce workload and financial burden on the health care system. However, several stakeholders expressed concerns regarding BPaL safety (monitoring), long-term efficacy, and national regulatory requirements regarding introduction of the regimen. Stakeholders stressed the importance of addressing current health systems constraints as well, especially in treatment and safety monitoring systems. Conclusions: Acceptability and feasibility of the BPaL regimen is high among TB stakeholders in Indonesia, Kyrgyzstan, and Nigeria. The majority is willing to start using BPaL as the standard of care for eligible patients despite country-specific health system constraints. © 2021, The Author(s).

Acceptability; BPaL; Feasibility; Implementation; Novel TB regimen; Pretomanid; XDR-TB


BMC Public Health

Publisher: BioMed Central Ltd

Volume 21, Issue 1, Art No 1404, Page – , Page Count

Journal Link:

doi: 10.1186/s12889-021-11427-y

Issn: 14712458

Type: All Open Access, Gold, Green


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