'And the stick to fight TB is TPT': nurse-identified barriers and facilitators of tuberculosis preventive therapy implementation in rural South Africa.

IF 3.4 3区 医学 Q1 RESPIRATORY SYSTEM
Megan A Grammatico, Anthony P Moll, Amiya Ahmed, Lauretta E Grau, Sipho Nsele, Philile Makhunga, Justin Jones, Sheela V Shenoi
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Abstract

Background: A decade after South Africa adopted tuberculosis preventive therapy (TPT), uptake remains sub-optimal.

Methods: Senior nurses at primary care clinics participated in semistructured individual interviews. Transcripts were thematically analysed to assess knowledge and attitudes towards TPT in rural South Africa.

Results: Among 22 senior nurses, 86% were female, with the median age of 39 years, and mean of 13.3 years' experience. Participants identified key individual-level barriers among nurses, interpersonal barriers that nurses observed among their patients and organisational barriers. While the nurses' belief in TPT efficacy was strong, their perceived barriers to TPT implementation included inflexible clinical guidelines, insufficient training and time to counsel patients, pill burden, patients' perceived HIV stigma and patients' alcohol use. Nurses believed implementation could be facilitated with task-shifting and integrating TPT into the antiretroviral (ART) infrastructure in primary care clinics and into chronic medication dispensing programmes. Shorter TPT regimens (eg, 12 weeks weekly INH/rifapentine: 3HP) were considered advantageous.

Conclusions: Nurses identified multiple barriers to TPT implementation, including insufficient training and time to counsel patients, pill burden, HIV stigma and alcohol use. Nurses suggested task-shifting, TPT/ART integration and rollout of 3HP as potential facilitators of TPT implementation in rural South Africa. Nurses' perspectives are essential to informing TPT implementation efforts in resource-limited settings.

“抗击结核病的大棒是TPT”:护士确定的南非农村实施结核病预防治疗的障碍和促进因素。
背景:在南非采用结核病预防治疗(TPT)十年后,摄取仍然不够理想。方法:对初级保健诊所的高级护士进行半结构化的个人访谈。对成绩单进行主题分析,以评估南非农村对TPT的知识和态度。结果:22名高级护士中,女性占86%,中位年龄39岁,平均工作年限13.3年。参与者确定了护士中主要的个人障碍,护士在患者中观察到的人际障碍和组织障碍。虽然护士对TPT疗效的信念很强,但他们认为实施TPT的障碍包括临床指南不灵活、培训和咨询患者的时间不足、药丸负担、患者认为的艾滋病毒耻辱和患者使用酒精。护士们认为,通过任务转移和将TPT纳入初级保健诊所的抗逆转录病毒(ART)基础设施和慢性药物配药规划,可以促进TPT的实施。较短的TPT方案(例如,每周12周INH/利福喷丁:3HP)被认为是有利的。结论:护士确定了实施TPT的多重障碍,包括培训不足和咨询患者的时间不足,药丸负担,艾滋病毒耻辱和酒精使用。护士建议将任务转移、TPT/ART整合以及3HP的推出作为在南非农村实施TPT的潜在促进因素。在资源有限的情况下,护士的观点对于为TPT的实施工作提供信息至关重要。
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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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