Perceived barriers and facilitators to implementing preventive therapy for tuberculosis in Malaysian prisons: Perspectives from prison personnel

Tuberculosis (TB) is a major health threat worldwide. TB is concentrated in prisons, where TB preventive therapy (TPT) implementation has been limited. Prisons generally, and especially in Malaysia, are overcrowded, minimally resourced, and have high prevalence of latent TB. As prison personnel are largely responsible for TPT implementation, their perspectives were sought to identify barriers and potential solutions for implementing TPT in Malaysias largest prison. A focus group using nominal group technique (NGT) was conducted with 9 prison officers with experience related to TPT to generate a list and rank-order the top TPT barriers. The process was repeated to assess facilitators. The top three barriers to implementing TPT were: 1) disruptions involved in prison activities (e.g., intra- and extra-prison transfers; 8 votes); 2) insufficient workforce (5 votes), and unanticipated inter-prison transfers (4 votes). Potential solutions included implementing care coordination protocols between officers and medical staff (8 votes), placing a medical hold until TPT completion (5 votes), and improving medication delivery logistics (4 votes). All prison officers supported a short-course TPT regimen administered once-weekly for 12 weeks (i.e. rifapentine and isoniazid (3HP)), over a daily TPT regimen for 6 months (i.e. isoniazid (26H)), due to less logistics and staff time required. From the perspective of prison officer stakeholders, logistical constraints commonly observed in prisons were perceived to impact the implementation of TPT, yet they prioritized pragmatic solutions that align with known implementation strategies to employ to optimize TPT delivery, including developing stakeholder relationships between medical and prison personnel and changing infrastructure to address frequent transfers within and between prisons and the community.