RATIONS Study intervention.

A qualitative study was conducted during the RATIONS trial to explore the perceptions, experiences, and expectations of participants and stakeholders on the acceptability, benefits, and feasibility of the nutritional intervention to complement the trial findings for deeper exploration into why and how of these findings and other allied themes. Using purposive sampling, we recruited 58 individuals for 22 in-depth interviews (IDI) and four focus group discussions (FGDs) between January and June 2022. These included 12 patients with TB, six household contacts, and other stakeholders (18 trial members, 18 government community workers, and four National TB Elimination Program (NTEP) staff). All IDIs and FGDs were audio-recorded, transcribed, and translated. The codes were generated using an inductive process and categorized manually into themes, with direct quotes describing the themes. The intervention was found to be acceptable in terms of cultural compatibility, quality, quantity, and duration; considered beneficial in helping tolerate the adverse effects of medications, weight gain, and resuming work; and was considered life-saving by many during the COVID-19 pandemic. Other observations included food-sharing in the control arm, inability to regain pre-disease functional status despite weight gain, and preference for in-kind support. Community health workers expressed confidence in its feasibility and willingness to take responsibility for its implementation. The NTEP staff considered it feasible if necessary resources were provided. This qualitative inquiry reflected the perspectives and lived experiences of households experiencing poverty, food insecurity, TB and the stakeholders serving them. Their voices are relevant in framing policy and practice in the NTEP and future research in India and similar low-resource settings. The food-based intervention was perceived as acceptable, feasible, and beneficial for the recipients and the NTEP. Opinion on cash or support in kind was divided; many preferred in-kind support over cash, but others expressed a requirement for both.

本研究在RATIONS试验期间开展定性研究，旨在探索受试者与利益相关方对营养干预方案的接受度、获益性与可行性的认知、体验及预期，以补充试验结果，深入探究该结果的成因、机制及其他相关主题。本研究于2022年1月至6月期间，采用目的抽样法招募了58名受试者，开展22次深度访谈（in-depth interviews, IDI）与4次焦点小组讨论（focus group discussions, FGDs）。受试者涵盖12名结核病（tuberculosis, TB）患者、6名家庭密切接触者，以及其他利益相关方：18名试验团队成员、18名政府社区工作者与4名国家结核病消除计划（National TB Elimination Program, NTEP）工作人员。所有深度访谈与焦点小组讨论均进行录音、转录与翻译。编码采用归纳法生成，并由人工划分为不同主题，同时辅以直接引语对主题进行阐释。研究发现，该营养干预方案在文化适配性、品质、供给量与实施时长方面均具有可接受性；其可帮助受试者耐受药物不良反应、实现体重恢复并重返工作，诸多受试者在新型冠状病毒肺炎（COVID-19）大流行期间甚至认为该方案挽救了自身生命。其他观测结果包括对照组存在食物共享行为、尽管体重有所恢复但受试者仍无法恢复至患病前的功能状态，以及受试者对实物支持的偏好。社区工作者对该方案的可行性抱有信心，并愿意承担其实施的相关责任。国家结核病消除计划工作人员则认为，只要配备必要资源，该方案具备实施可行性。本定性研究展现了贫困、粮食不安全、结核病患者家庭及其服务方的认知与真实经历。这些声音可为国家结核病消除计划的政策制定与实践优化，以及印度及其他类似低资源环境下的未来研究提供参考。总体而言，该食品类营养干预方案在受试者与国家结核病消除计划工作人员眼中均具备可接受性、可行性与获益性。对于现金支持与实物支持的选择，各方意见存在分歧：多数受试者更倾向于实物支持，但也有群体认为二者缺一不可。