Introduction: Diagnosing and treating tuberculosis (TB) infection are critical to reducing TB mortality among people with HIV (PLHIV). Blood-based screening using QuantiFERON-TB Gold Plus (QFT+) and shorter-course TB preventive therapy (TPT) regimens such as 3-month weekly isoniazid and rifapentine (3HP) hold promise to improve TB outcomes.

Methods: We conducted 38 qualitative interviews to explore implementation challenges and solutions related to QFT+ use and TPT uptake among PLHIV participating in the PREVINE-TB study in Brazil and utilized thematic analysis.

Results: Clinic and provider implementation innovations and examples of positive deviance helped explain quantitative differences in QFT+ use and TPT uptake between cities including predetermination of eligible patients for QFT+ screening based on nurse review of electronic medical records, specialized TB clinics, the use of TPT Champions, and digital communication.

Conclusions: Clinic and provider innovations can support QFT+ use and TPT uptake to improve TB outcomes, including in the context of health systems challenges.