Table 2 Health worker-reported barriers to and facilitators of the use, completion, and models of delivery for 3HP at Mulago AIDS clinic in Kampala, Uganda

Common cause of mortality among stable PLHIV - In this clinic, of the 16,000 patients, most are stable and if you look at the cause of mortality it is TB related. … So, it deserves much attention. (Medical Doctor at the clinic)

Inadequate understanding of TB and TPT - Some people think that TB is in a family, that it’s hereditary. So, they will tell you, “You know my father had TB, so I also have TB or me I can’t have TB in our family, no one has ever had TB”. Such people will not adhere well on treatment. (Nurse at the clinic)

PLHIV trust their health workers - If you explain to them the benefits of taking this preventive treatment, they are usually receptive, and they usually take health workers information as kind of gospel truth. (Medical Doctor at the clinic)

Stigma associated with TB - We get challenges in trying to implement infection control procedures here because of the stigma associated with it even in the clinic. (Nurse at the clinic)

Fear of TB- They think ...someone may die if they get the disease. They really have a great fear of the disease…. when they hear that there are preventive measures, everyone will want to take it to prevent them from not getting TB. (Nurse at the clinic)

Fear of potential side effects - “Balese biragala kututta.” (this literally means they have brought medications to kill us) … And then other people think that the TB prevention medications, are very strong, they are very toxic that they will affect the liver and the kidney. (Nurse at the clinic)

Receptiveness to TPT - They seem to be eager to take the medicine including some requesting for it even though it was not prescribed for them …. They would say how come for me I haven’t received? ….… So, when they hear of the preventive treatment, they will not hesitate to start the drugs. (Pharmacy Technician at the clinic)

Potential pill burden - Musawo (meaning health worker in the local language), I have been concentrating on my triple (three daily ARV pills) and now you want to give me more medication. …some of them are not so positive about it. (Medical Doctor at the clinic)

Once-weekly 3HP dosing schedule - Taking it once a week rather than taking it daily much as the tablets are many. Maybe one will be like “anyway am taking many but once a week”. (Medical Doctor at the clinic)

Perceived challenges of DOT - Their work schedule I don’t think it would allow them to come weekly. ….. most of our clients they are not self-employed, they are employed, and they have not disclosed……. So, it’s very hard for someone to ask for permission every week the boss will get suspicious…. others travel long distances; others travel a lot. (Nurse at the clinic)

Streamlined clinic visits - If there is one specific staff, let me say nurse giving out this medicine it will help the patient and the clinic……… the patient will know where to go and not meander around. And even for the health workers, it will maximize the patient flow and the congestion in the clinic. (Nurse at the clinic)

Perceived challenges of SAT - In DOT they take the medicine when you are really seeing, you can be sure that they are taking it. But for those ones taking it from home, sometimes they can take less, and you can’t know. (Nurse at the clinic)

Perceived benefits of DOT - First, when this person comes weekly, the health worker will be able to see if there is any change; early detection of side effects that is one. And then second you are going to be sure this person has taken his or her medication. Because you are going to be there and see. (Nurse at the clinic)

Technology challenges - Technology no, mostly we depend on self-report, pill count, say I have been taking so what is your balance? Then you negotiate around that. Technology no. (Nurse at the clinic)

Perceived benefits of SAT - First, the time you spend coming to the hospital, you save that time and transport. You would be doing some other things instead of coming to the hospital. And this person secures his or her job, yes. (Nurse at the clinic)