Health system-related barriers and facilitators to tuberculosis preventive treatment: a qualitative case study comparing implementation in the Republic of Moldova and Georgia.

IF 3.4 3区 医学 Q1 RESPIRATORY SYSTEM
Zaruhi Mkrtchyan, Valentina Vilc, Maka Danelia, Askar Yedilbayev, Anna M Foss, Patrick Nguipdop-Djomo, Andrei Dadu
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引用次数: 0

Abstract

Introduction: Despite WHO's recommendations and the 2023-2030 Tuberculosis (TB) action plan, uptake of TB preventive treatment (TPT) remains suboptimal. In this paper, we use two countries of the WHO Europe Region, the Republic of Moldova and Georgia, that are at different stages of implementation of TB prevention policies, as a case study to examine health system barriers and facilitators to TPT scale-up.

Methods: In this case study, we used methods of qualitative research-interviews with three stakeholder groups: health service providers and National TB Programme staff; civil society organisations and international partners or donors. The data were collected via videoconference, transcribed, then coded and analysed using NVivo V.14. Thematic analysis was conducted.

Results: Facilitators for TPT delivery in both settings include an established TB clinical network, well-functioning communication systems and an uninterrupted supply of TPT medicines.In both settings, healthcare providers generally exhibit positive attitudes towards treating TB infection; however, some remain sceptical and cautious, particularly regarding prescribing TPT without confirmation of TB infection, a challenge compounded by limited access to testing for TB infection. Evidence of TB infection is also important for patients' decisions on initiation and adherence to treatment. Other barriers to effective service delivery of TPT include shortages and high workload of primary healthcare personnel, ambiguity in the role of family doctors in the management of TPT and low prioritisation of TPT during regular monitoring visits.

Conclusions: The case study identified similar challenges in the rollout of TPT across both settings, highlighting common barriers hindering effective implementation. For optimal TPT rollout, enhancing provider confidence, improving access to testing for TB infection and strengthening integration with primary healthcare with refined roles of family doctors are essential. Both settings would also benefit from improved monitoring and evaluation systems and prioritisation of TB prevention in monitoring.

与卫生系统相关的结核病预防治疗障碍和促进因素:摩尔多瓦共和国和格鲁吉亚实施情况比较的定性案例研究。
导言:尽管世卫组织提出了建议并制定了《2023-2030年结核病行动计划》,但结核病预防性治疗(TPT)的接受情况仍不理想。在本文中,我们以世卫组织欧洲区域处于结核病预防政策实施不同阶段的两个国家——摩尔多瓦共和国和格鲁吉亚——作为案例研究,考察卫生系统对推广TPT的障碍和促进因素。方法:在本案例研究中,我们使用了定性研究的方法-对三个利益相关者群体进行访谈:卫生服务提供者和国家结核病规划工作人员;民间社会组织和国际合作伙伴或捐助者。通过视频会议收集数据,转录,然后使用NVivo V.14进行编码和分析。进行了专题分析。结果:在这两种情况下提供TPT的促进因素包括建立结核病临床网络、运转良好的通信系统和不间断的TPT药物供应。在这两种情况下,卫生保健提供者通常对治疗结核病感染表现出积极的态度;然而,一些人仍然持怀疑态度和谨慎态度,特别是在没有确认结核感染的情况下开TPT处方,这一挑战由于获得结核感染检测的机会有限而更加复杂。结核病感染的证据对患者决定是否开始和坚持治疗也很重要。有效提供TPT服务的其他障碍包括初级卫生保健人员的短缺和高工作量,家庭医生在TPT管理中的作用不明确,以及定期监测访问期间TPT的优先级较低。结论:该案例研究确定了在两种情况下推广TPT时面临的类似挑战,突出了阻碍有效实施的共同障碍。为了优化TPT的推广,增强提供者的信心,改善结核病感染检测的可及性,加强与初级卫生保健的整合,完善家庭医生的作用是至关重要的。这两种情况也将受益于改进的监测和评估系统以及在监测中优先考虑结核病预防。
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来源期刊
BMJ Open Respiratory Research
BMJ Open Respiratory Research RESPIRATORY SYSTEM-
CiteScore
6.60
自引率
2.40%
发文量
95
审稿时长
12 weeks
期刊介绍: BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
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