Bridging programmatic gap in post-TB treatment prevention: applying the COM-B model and Behavior Change Wheel to improve the uptake of TB preventive therapy

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ID: 329492
2026
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Abstract
Abstract Uganda’s National Tuberculosis and Leprosy Program (NTP) recommends tuberculosis preventive therapy (TPT) immediately after TB treatment completion (hereafter post-TB treatment TPT or PTT-TPT) for people with retreatment TB, as they are at high risk for recurrent/drug-resistant TB. However, uptake of PTT-TPT is limited. To examine determinants of uptake, identify program-relevant strategies, and improve implementation, we applied a behavioral framework. We used the COM-B model (Capability-Opportunity-Motivation Behavior) to conceptualize the behavioral and health system determinants and the Behavior Change Wheel (BCW) to map the determinants to potential programmatic actions. The COM-B model showed that the low uptake of PTT-TPT reflects interacting limitations in healthcare provider capability, opportunity, and motivation. Based on the BCW, interventions aligned with behavioral drivers could help the NTP and similar settings to integrate PTT-TPT prevention more effectively within routine TB care. In conclusion, addressing the behavioral determinants of PTT-TPT may strengthen uptake.
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openalex_W7214062427 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Jonathan Izudi, Christine Sekaggya‐Wiltshire, Andrew D. Kerkhoff, Adithya Cattamanchi
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Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag601
URL
https://doi.org/10.1093/ofid/ofag601
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