Megan A Grammatico, Anthony P Moll, Amiya Ahmed, Lauretta E Grau, Sipho Nsele, Philile Makhunga, Justin Jones, Sheela V Shenoi
{"title":"“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。","authors":"Megan A Grammatico, Anthony P Moll, Amiya Ahmed, Lauretta E Grau, Sipho Nsele, Philile Makhunga, Justin Jones, Sheela V Shenoi","doi":"10.1136/bmjresp-2024-002663","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>A decade after South Africa adopted tuberculosis preventive therapy (TPT), uptake remains sub-optimal.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"'And the stick to fight TB is TPT': nurse-identified barriers and facilitators of tuberculosis preventive therapy implementation in rural South Africa.\",\"authors\":\"Megan A Grammatico, Anthony P Moll, Amiya Ahmed, Lauretta E Grau, Sipho Nsele, Philile Makhunga, Justin Jones, Sheela V Shenoi\",\"doi\":\"10.1136/bmjresp-2024-002663\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>A decade after South Africa adopted tuberculosis preventive therapy (TPT), uptake remains sub-optimal.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":9048,\"journal\":{\"name\":\"BMJ Open Respiratory Research\",\"volume\":\"12 1\",\"pages\":\"\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2025-09-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMJ Open Respiratory Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/bmjresp-2024-002663\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Open Respiratory Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjresp-2024-002663","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
'And the stick to fight TB is TPT': nurse-identified barriers and facilitators of tuberculosis preventive therapy implementation in rural South Africa.
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.
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.