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

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.