Implementation strategies for integrating TB treatment into community pharmacies for people with TB/HIV in Uganda using human-centered design methodology
Izudi, J., Cattamanchi, A., Sekaggya-Wiltshire, C., King, R., Kiwanuka, N., Sammann, A.
public and global health
Quick verdict
HCD co-design with TB/HIV stakeholders yields a 4-component pharmacy refill strategy; process solid, but all-max rankings and SUS data lack discrimination.
Summary
This preprint reports the inspiration and ideation phases of a human-centered design (HCD) effort to develop an implementation strategy for integrating TB medication refills into community pharmacies already providing ART refills to stable people with HIV in Kampala, Uganda. Building on a prior CFIR-guided qualitative study plus pharmacy observations, the authors derived five themes, five insight statements, five design opportunities, and 26 low-fidelity prototypes. A two-day co-design workshop with 36 stakeholders (people with TB/HIV, TB and HIV focal persons, MoH DSD experts, pharmacy providers) ranked prototypes on desirability, feasibility, and viability; nine prototypes were selected, each with a mean rank of 5.0. Four high-fidelity prototypes were then evaluated with the System Usability Scale (SUS) by 15 participants, yielding mean scores of 85.2-95.2, all well above the conventional benchmark of 68. The retained items were synthesized into a four-component strategy: awareness/trust building, standardized same-day ART/TB refill workflows, pharmacy certification and training, and monitoring via SOP manuals and side-effect checklists. A pilot randomized trial is planned. Key limitations include ceiling-effect rankings with no distributional data, SUS applied to non-software artifacts by co-designing participants, an unreported number of refinement iterations, and a 9-versus-8 prototype accounting discrepancy.
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Assessment at a glance
5
risk flags identified
● high 0
● medium 3
● low 2
4 strengths · 5 weaknesses · 5 author questions
AI text signal = Binoculars zero-shot detector score over 20 sampled passages (Fast-DetectGPT co-reported) — absence does not prove human authorship, and a flag does not imply misconduct.
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Key claims under review
- Stakeholder co-design using HCD produces a four-component implementation strategy — awareness/trust building, standardized same-day ART+TB refill workflows, pharmacy certification/accreditation with targeted training, and monitoring via SOP manuals plus side-effect checklists — deemed acceptable and feasible by all stakeholder groups.
- Of 26 low-fidelity prototypes, nine were prioritized, each rated at the maximum mean rank of 5.0 for desirability, feasibility, and viability.
- Four high-fidelity prototypes achieved excellent usability, with mean SUS scores of 85.2-95.2 (n=15), far above the conventional benchmark of 68.
- The adapted strategy and prototypes will be evaluated in a planned pilot individually randomized, type 2 hybrid effectiveness-implementation trial at two Kampala facilities.
Strengths
Genuinely broad stakeholder participation
Table 1 shows 36 workshop participants across five role groups, including 9 people with TB/HIV, 9 community pharmacy HCPs, 6 TB focal persons, 6 HIV focal persons, and 6 MoH DSD experts; the Discussion notes MoH experts joined all HCD phases, which supports eventual programmatic buy-in.
Traceable evidence-to-strategy chain
The pipeline from five themes (Results, Inspiration phase) to five insight statements, five design opportunities, and 26 prototypes is laid out in Table 2, and Table 6 assigns each strategy component named responsible entities (focal persons, MoH/NTP, pharmacy HCPs), making the output actionable for the planned pilot trial.
Ethics and process transparency
Iterative two-round testing with a standardized instrument
Weaknesses
Ranking evidence has no discriminating power as reported
SUS applied well outside its validated scope, with weak normative anchoring
Allegiance bias in usability ratings
Adaptive SUS loop reported only at its endpoint
Internal accounting inconsistencies and aggregation opacity
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Scope & Claims
This medRxiv preprint (posted September 17, 2026) reports the inspiration and ideation phases of a human-centered design (HCD) study across six primary health facilities in Kampala, Uganda, aiming to adapt an implementation strategy for integrating TB medication refills into community pharmacies already dispensing ART under Uganda's differentiated service delivery (DSD) model. The author group overlaps with a prior CFIR-guided qualitative study (ref 17) and a published protocol (ref 18). The central claim is that stakeholder co-design produced a four-component strategy — awareness/trust building; standardized same-day ART+TB refill workflows; certification/accreditation with targeted TB training; and monitoring via SOP manuals and side-effect checklists (Table 6) — with excellent usability, to be tested in a planned pilot randomized trial. Claims are appropriately scoped to strategy development rather than effectiveness, but the quantitative evidence presented is weaker than the framing suggests.
The remaining sections cover Methodology Assessment, Statistical Evidence, Results & Reproducibility, Limitations & Risks, and Verdict & Recommendations.
- All 4 strengths & 5 weaknesses, analyzed in detail
- 5 risk flags with severity, section & reviewer questions
- Methods & statistical evidence assessment
- 5 questions a peer reviewer would ask
- Full six-dimension evaluation report & recommendations
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Frequently asked questions
What is this paper about?
It is a preprint describing how researchers used human-centered design — co-design workshops with people who have both TB and HIV, clinic staff, pharmacy workers, and Uganda Ministry of Health experts in Kampala — to develop a four-part strategy for letting such patients refill their TB medication at community pharmacies instead of clinics.
What were the System Usability Scale (SUS) scores?
The four refined prototypes scored means of 95.2 (side-effect checklist), 90.2 (SOP manual), 86.1 (integrated refill workflow), and 85.2 (dispensing visual workflow) on the 0-100 SUS, well above the conventional benchmark of 68. Note the 15 raters had helped design the prototypes, which can inflate scores.
Was this a clinical trial?
No. The paper covers only the inspiration and ideation (design) phases. A pilot randomized trial comparing pharmacy-based TB/ART refills with usual care at two Kampala facilities is planned as the implementation phase.
What are the four components of the implementation strategy?
(1) Awareness and trust building for pharmacy TB refills led by TB and HIV focal persons; (2) standardized same-day ART and TB refill workflows with SOPs and visual diagrams; (3) pharmacy certification, accreditation, and targeted TB training by the Ministry of Health; (4) quality monitoring via SOP manuals and a standardized TB drug side-effect checklist.
About this review
This is an AI-generated preliminary review by Evolve.Pub, produced from the openly available text of the paper. It is not peer review and does not represent the authors' views. The canonical record of the paper is at the publisher link above.
- Supplementary materials (S1-S5 files, S1/S2 figures, S1 Data) are referenced but were not included in the extracted text, so the actual prototypes and raw SUS/ranking data could not be inspected.
- Table rows were flattened by text extraction; only the single 'Mean rank' column of Table 3 was visible, not any per-criterion values.
- Funding, data-availability, and competing-interest statements were not present in the extracted text.
- This is a non-peer-reviewed preprint (posted September 17, 2026); page-watermark text overlapped some lines but did not obscure substantive content.
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