Table 5.

Preferences for improvement of TEC

Preference	Quote
Preference for group TEC sessions with the opportunity for discretionary individual counselling	‘So, when we come together as TB patients and learn from each other… In addition, the questions you might have as an individual you will ask as an individual and yet if you are in a group, you will also hear what others have to say, including things you might have forgotten! Someone will ask about them and you will gain from being there.’ (Female TB patient, TB FGD) ‘… we have different challenges and sometimes health workers never get to know about our challenges. Even with the availability of counsellors, when you get to them, they ask what is on the form and what you are suffering from…but each of us have our questions that we cannot speak about in public; we need a way where someone can meet a health worker in private.’ (Male TB patient, TB FGD 5) We could also encourage the group counselling; this way we reduce the time we are spending on each client… if we talk to them as a group, we reduce the waiting time. It [the group counselling] is difficult for the new clients though.’ (HIV clinic HCW, HCW FGD 4)
Desire for more consistent and standardized provision of and training for TEC	‘Each time I return to pick medication, I should receive TEC.’ (Male TB patient, TB FGD 1) ‘It would be good to repeat due to forgetting. You might come here, and you find the health worker educating someone or some people, you sit in and listen. Because you might already have had your medication and are taking it but when you come and find a session, it helps you learn a bit more and it would help me a lot.’ (Male TB patient, TB FGD 2) ‘…we interact these patients at the time of diagnosis, then every 2 weeks when they are in the initial phase and then monthly in the continuation phase. And so, whenever they come visit, I think it’s important to put in some more information so that they get reminded.’ (TB clinic HCW, HCW FGD 4) ‘So, what I am saying, counselling skills, in some people, [they are] half-baked. So, when you are fully having counselling skills… [even] if there is no time but the patient will appreciate what you have done.’ (TB clinic HCW, HCW FGD 4)
Preferences for TEC providers	‘I think anyone who is trained to counsel and has the interest to pass the information [to patients] … can do the counselling.’ (TB clinic HCW, HCW FGD 4) ‘I prefer the doctor because it is easy for them to understand your complaints and find a solution. And this might not be the same with the CHWs who might have to consult first. They on their own might not have learnt about what you are asking about and must consult their seniors and yet for the doctor this is what they study, and they have the experience. They are therefore able to tell you that this is what it is.’ (Male TB patient, TB FGD 1) ‘In my opinion, the health worker who when I come here treats me and gives me my medication should be the one to offer me TB…counselling’ (Male TB patient, TB FGD 2) ‘… a former TB patient, who knows well how TB feels, who knows how tablets are swallowed, should be the right person…. take him or her for training and that person, right from what he/she experienced, …remember that person has suffered from TB before, just the same way it is when it comes to HIV, it is the HIV infected persons who give those health education talks, those who take ARVs [antiretroviral drugs], who know how hard it is to take ARVs, are the ones who educate us. It should be done in a similar way. You should get people who have ever been infected with TB, who have ever been on TB medication…they know what it means to take TB medicines because it is not easy to take this medicine and should be the ones to educate TB patients. That is what I propose.’ (Female TB-HIV patient, TB FGD 7)

Abbreviations: CHW, community health worker; FGD, focus group discussion; HCW, health care worker; TB, tuberculosis; TEC, TB education and counselling