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