Factors associated with low tuberculosis preventive therapy prescription rates among health care workers in rural South Africa

Abstract

Background Despite extensive rollout of tuberculosis preventive therapy (TPT) in South Africa to reduce the incidence of tuberculosis among people living with HIV (PWH), rates of initiation and completion have remained suboptimal. Objective This study aimed to identify factors associated with low TPT prescription rates among health care workers (HCWs) in rural South Africa. Methods A cross-sectional study was conducted using an anonymous 39-item questionnaire guided by the Consolidated Framework for Implementation Research (CFIR). HCWs from a government district hospital and 14 primary healthcare clinics (PHCs) in the rural Msinga sub-district of KwaZulu-Natal were surveyed from November 2019 to January 2020. Self-reported data on prescription rates as well as knowledge, attitudes, beliefs, and practices regarding isoniazid preventative therapy, the current TPT regimen, were obtained. Factor analysis and logistic regression were used to determine associations with low prescription rates (< 50% of PWH) for TPT prescribers, and results were placed within CFIR-driven context. Results Among 160 HCWs, the median (IQR) age was 39 (33–46) years, 76% were women, 78% worked at a PHC, and 44% had experience prescribing TPT. On multivariable analysis, prescribers (n = 71) who believed their patients would not disclose TPT use to others were significantly less likely to prescribe TPT (aOR 4.19 95% CI 1.35–13.00; p = 0.01). Inadequate isoniazid supplies trended towards significance (aOR 10.10 95% CI 0.95–106.92; p = 0.06) in association with low prescription rates. Conclusions Strengthening HCW training to emphasize TPT prescription to all eligible PWH regardless of beliefs about patient disclosure and ensuring a consistent isoniazid supply at the health systems-level are both critical steps to enhancing TPT implementation in rural South Africa.

Incidence of active tuberculosis among people living with HIV receiving long‐term antiretroviral therapy in high TB/HIV burden settings in Thailand: implication for tuberculosis preventive therapy

“…Unfortunately, the uptake of TPT is relatively low in many Asian countries even though Asia and pacific have the highest TB burden. Although studies are lacking in the Asia‐Pacific region on why there is low TPT uptake, several studies have reported the providers’ barriers in initiating TPT, including lack of training and their perceptions on its efficacy or clarity of TPT guidelines [ 26 , 27 , 28 ]. Thailand is among the top 14 high burden (highest TB and TB/HIV) countries [ 1 ].…”

The contribution of late HIV diagnosis on the occurrence of HIV-associated tuberculosis

“…Latent TB is estimated very prevalent in Mexico, Peru and Uganda, and the treatment with preventive therapy may be important, as it is early ART, for the clinical outcomes and may impact in our results. It is unlikely that a significant proportion of persons entering HIV care in our cohorts, received TB preventive therapy as during this study period, the uptake of this intervention was low [38]. Nonetheless, in some people who are actually initiating preventive therapy along with ART, this could have mitigated the risk of incident TB especially in those with low CD4 þ cell count at treatment initiation.…”

Development of an infectious disease prevention behavior model for public health center workers in a rural area of Indonesia

“…[21][22][23][24][25] Training also plays a role in encouraging the motivation of health personnel to be more active in using PPE, maintaining hand hygiene, changing masks before going to another patient. [30][31][32][33] Compensation is still included in the model even though there is only 1 supporting paper on predictors of the IPB. 38 Compensation is expected as the presence or support from the management to maintain performance of health personnel in accordance with the standards of the IPB.…”