Patient acceptance of preventive antibiotic treatment for tuberculosis: a qualitative study in London, UK
6 affiliations
- 1Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
- 2Infection and Immunity, University College London, London, UK
- 3UCL Respiratory, UCL, London, UK
- 4UCL, London, UK
- 5Institute of Infection, Immunity and Transplantation, UCL, London, UK
- 6Centre for Behaviour Change, University College London, London, UK
Abstract
Background Tuberculosis (TB) preventive treatment is a key component of TB control in low-incidence settings but uptake remains low.Objective To explore factors influencing patient decisions to accept or decline preventive treatment for TB infection.Design Qualitative study using semi-structured interviews, analysed with the Theoretical Domains Framework (TDF).Setting Routine clinical TB prevention services at two hospitals in London, UK.Participants Adults (≥18 years) diagnosed with TB infection and offered preventive treatment.Methods Semi-structured interviews were audio-recorded and transcribed verbatim. The TDF was applied to analyse transcripts using a combined inductive thematic analysis and deductive framework approach. Themes were also mapped to the capability, opportunity and motivation model of behaviour domains.Results Twenty-five participants (median age 34 years; 64% male) were included; 56% accepted treatment, 28% declined and 16% were undecided. Influences on decision-making mapped to 12 of 14 TDF domains. Facilitators of treatment acceptance included perceived risk of TB (beliefs about consequences), desire to protect others’ health (social influences and goals), confidence in treatment adherence (beliefs about capabilities) and routine integration strategies (behavioural regulation). Barriers to treatment acceptance included low perceived individual risk and doubts about necessity or effectiveness (beliefs about consequences), concerns about side effects and treatment burden (environmental context and resources) and anticipated stigma (social influences). Knowledge had a mixed influence on treatment decision making, primarily shaping perceived necessity, but did not determine decisions alone. Social, environmental and emotional factors further influenced decisions, with participants balancing anticipated benefits against perceived burden and uncertainty across multiple interacting domains.Conclusions Decisions to accept preventive TB treatment are driven by interacting capability, opportunity and motivation factors rather than knowledge alone. Interventions to improve shared decision making should address perceived risk, treatment burden, self-efficacy and social influences.Trial registration number NCT07024836.
Related
- Factors associated with acceptance of preventive treatment among older adults with latent tuberculosis infection in Huzhou, Zhejiang province: a cross-sectional study.
- High Initiation but Suboptimal Completion of Tuberculosis-Preventive Treatment Among People Living With HIV on Antiretroviral Therapy, Persistent Tuberculosis Incidence, and Programmatic Implications: Findings From a 2-Year Multicountry Cohort Study
- Determinants of willingness to accept Tuberculosis Preventive Treatment (TPT) among close contacts with Tuberculosis Infection (TBI) in Xinjiang, China
- Safety of tuberculosis-preventive treatment in children aged under 5 years: A rapid review.
- Not Sick, Yet Treated: Barriers and Facilitators to Tuberculosis Preventive Treatment Uptake Among Household Contacts of Tuberculosis Patients in Moulvibazar District, Bangladesh
BibTeX
@article{antunes2026patient,
title = {{Patient acceptance of preventive antibiotic treatment for tuberculosis: a qualitative study in London, UK}},
author = {Mélanie Antunes and Rubin Rose-Key and Ellen Steward and Sammy Assayad and Mahdad Noursadeghi and Luis Enrique Loría-Rebolledo and Elisa Crayton and Rishi Gupta},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-126587},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-126587},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Patient acceptance of preventive antibiotic treatment for tuberculosis: a qualitative study in London, UK
AU - Mélanie Antunes
AU - Rubin Rose-Key
AU - Ellen Steward
AU - Sammy Assayad
AU - Mahdad Noursadeghi
AU - Luis Enrique Loría-Rebolledo
AU - Elisa Crayton
AU - Rishi Gupta
PY - 2026
DA - 2026/10/23
JO - BMJ Open
DO - 10.1136/bmjopen-2026-126587
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-126587
AB - Background Tuberculosis (TB) preventive treatment is a key component of TB control in low-incidence settings but uptake remains low.Objective To explore factors influencing patient decisions to accept or decline preventive treatment for TB infection.Design Qualitative study using semi-structured interviews, analysed with the Theoretical Domains Framework (TDF).Setting Routine clinical TB prevention services at two hospitals in London, UK.Participants Adults (≥18 years) diagnosed with TB infection and offered preventive treatment.Methods Semi-structured interviews were audio-recorded and transcribed verbatim. The TDF was applied to analyse transcripts using a combined inductive thematic analysis and deductive framework approach. Themes were also mapped to the capability, opportunity and motivation model of behaviour domains.Results Twenty-five participants (median age 34 years; 64% male) were included; 56% accepted treatment, 28% declined and 16% were undecided. Influences on decision-making mapped to 12 of 14 TDF domains. Facilitators of treatment acceptance included perceived risk of TB (beliefs about consequences), desire to protect others’ health (social influences and goals), confidence in treatment adherence (beliefs about capabilities) and routine integration strategies (behavioural regulation). Barriers to treatment acceptance included low perceived individual risk and doubts about necessity or effectiveness (beliefs about consequences), concerns about side effects and treatment burden (environmental context and resources) and anticipated stigma (social influences). Knowledge had a mixed influence on treatment decision making, primarily shaping perceived necessity, but did not determine decisions alone. Social, environmental and emotional factors further influenced decisions, with participants balancing anticipated benefits against perceived burden and uncertainty across multiple interacting domains.Conclusions Decisions to accept preventive TB treatment are driven by interacting capability, opportunity and motivation factors rather than knowledge alone. Interventions to improve shared decision making should address perceived risk, treatment burden, self-efficacy and social influences.Trial registration number NCT07024836.
SN - 2044-6055
SN - 2044-6055
ER -