Healthcare worker perceived barriers and facilitators to implementing a tuberculosis preventive therapy program in rural South Africa: a content analysis using the consolidated framework for implementation research.
Healthcare worker perceived barriers and facilitators to implementing a tuberculosis preventive therapy program in rural South Africa: a content analysis using the consolidated framework for implementation research.
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DOI：
10.1186/s43058-023-00490-8
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发表时间：
2023-08-30
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南非国家结核病（TB）指南，根据世界卫生组织，建议进行常规的家庭结核病接触调查，并为符合条件的人提供结核病预防治疗（TPT）。然而，在南非农村地区，TPT的实施情况并不理想。我们试图确定南非东开普省农村地区结核病接触者调查和TPT管理的障碍和促进因素，为制定实施战略提供信息，以启动全面的结核病规划。我们收集了定性数据，通过个人半结构化的采访，19名医护人员在一家地区医院和四个周围的初级保健诊所提到医院。实施研究的综合框架（CFIR）被用来制定访谈问题，以及指导演绎内容分析，以确定实施成功或失败的潜在驱动因素。共有19名医护人员接受了采访。已确定的常见障碍包括提供者缺乏关于TPT疗效的知识，临床医生缺乏TPT文档工作流程以及广泛的社区资源限制。确定的促进因素包括医护人员对了解TPT有效性的高度兴趣，对解决提供全面结核病护理（包括TPT）的后勤障碍的兴趣，以及对诊所和护士领导的结核病预防工作的愿望。CFIR是一个经过验证的实施决定因素框架，它的使用为确定结核病家庭接触调查的障碍和促进因素提供了一种系统的方法，特别是在农村结核病高负担环境中提供和管理TPT。需要特定的资源（时间、培训和证据）来确保医疗保健提供者在更广泛地开出TPT处方之前对TPT感到了解和有能力。改进数据系统等可持续资源，加上政治协调和为贸易、技术和贸易方案拟订提供资金，对于可持续性至关重要。在线版本包含补充材料，可通过10.1186/s43058-023-00490-8获得。
South African national tuberculosis (TB) guidelines, in accordance with the World Health Organization, recommend conducting routine household TB contact investigation with provision of TB preventive therapy (TPT) for those who qualify. However, implementation of TPT has been suboptimal in rural South Africa. We sought to identify barriers and facilitators to TB contact investigations and TPT management in rural Eastern Cape, South Africa, to inform the development of an implementation strategy to launch a comprehensive TB program. We collected qualitative data through individual semi-structured interviews with 19 healthcare workers at a district hospital and four surrounding primary-care clinics referring to the hospital. The consolidated framework for implementation research (CFIR) was used to develop interview questions as well as guide deductive content analysis to determine potential drivers of implementation success or failure. A total of 19 healthcare workers were interviewed. Identified common barriers included lack of provider knowledge regarding efficacy of TPT, lack of TPT documentation workflows for clinicians, and widespread community resource constraints. Facilitators identified included healthcare workers high interest to learn more about the effectiveness of TPT, interest in problem-solving logistical barriers in provision of comprehensive TB care (including TPT), and desire for clinic and nurse-led TB prevention efforts. The use of the CFIR, a validated implementation determinants framework, provided a systematic approach to identify barriers and facilitators to TB household contact investigation, specifically the provision and management of TPT in this rural, high TB burden setting. Specific resources—time, trainings, and evidence—are necessary to ensure healthcare providers feel knowledgeable and competent about TPT prior to prescribing it more broadly. Tangible resources such as improved data systems coupled with political coordination and funding for TPT programming are essential for sustainability. The online version contains supplementary material available at 10.1186/s43058-023-00490-8.